WY 195 H496p 1919
NATIONAL LIBRARY OF MEDICINE
SURGEON GENERAL'S OFFICE
no. 113, No. -c2-djl-aLL4
W. D. S. G. O. / 5-613
PRACTICAL HOME NURSING
THE M ACM ILL AN COMPANY
NEW YORK • BOSTON • CHICAGO - DALLAS
ATLANTA • SAN FRANCISCO
MACMILLAN & CO., Limited
LONDON • BOMBAY • CALCUTTA
THE MACMILLAN CO. OF CANADA, Ltd.
AN ELEMENTARY CONDENSED TEXT-
BOOK FOR TRAINED ATTENDANTS
LOUISE HENDERSON, R.N.
Director of Trained Attendant Classes, Ballard School,
Central Branch Y. W. C. A. of New York
THE MACMILLAN COMPANY
All rights reserved
By THE MACMILLAN COMPANY
Set up and electrotyped. Published January, 1919.
jan 22 1919
During a period of some years in teaching classes for
Trained Attendants the need has been felt for a simple
textbook. This little book, therefore, is based on the requi-
site knowledge for such courses and covers only just
enough anatomy and physiology to make clear the reasons
for the practical work involved.
Care has been taken to define clearly and accurately the
different steps in the necessary technique of simple treat-
ments and the care and comfort of the patient. The
treatment in cases of common emergencies has been out-
lined ; the subject of acute disease and the treatment pecul-
iar to such conditions has purposely not been discussed.
Structure of the Body
Origin. Skeleton. Bones. Cavities. Organs. Skin.
Membranes. Nervous System.
Composition of Blood. Preparations for Blood Tests.
Structure and Function of Heart and Blood Vessels.
Circulation of the Blood. Lymphatics. Structure and
Function of the Lungs. Method of Counting Respira-
tion and Pulse. Variations in Body Temperature and
Methods of Taking It.
The Urinary Tract
Structure and Function of the Kidneys. Bladder.
Composition and Normal Amount of Urine. Securing
The Digestive Tract
Functions of Digestive Organs. Process of Diges-
tion. Food Elements. Diet. Serving Food. Ar-
ranging Tray. Feeding Patient.
Circulation of the Blood
CHAPTER VI page
Constituents of Air. Causes of Impurities. Neces-
sity of Ventilation. Methods of Ventilating a Sick
Origin. Bacteria in Disease and in Wounds. Im-
portance of Preventive Measures. Sterilization. Prac-
tical Methods for Disinfecting Discharges. Common
Model Sick Room 60
Ideal Room. Furnishings. Care of Room. Meth-
ods of Cleaning. Bed and Bedding. Making Bed and
Changing Bedding. Arranging Pillows. Use of
Moving and Lifting 74
Practical Methods of Moving Patients Comfortably.
Structure and Function of the Skin. Importance of
Bathing. Methods of Giving Different Kinds of
Baths. Personal Care of Patient.
Bed Sores 93
Causes of Pressure Sores. Practical Methods of
Preventing Their Development.
Methods of Giving Different Kinds of Enema. Irri-
gations and Douches.
CHAPTEK XIII page
External Applications 106
Dry and Moist Heat. Poultices. Stupes. Counter
Irritants. Ice Bags. Compresses.
Important Rules to be Observed in tbe Care and
Giving of Medicines. Table of Measures.
General Observation of Symptoms. Relation of One
Symptom to Another. Methods of Keeping a Written
Special Care in Conditions of the Female Generative
Structure and Function of Female Generative Or-
gans. Positions for Examination. Dorsal. Sims.
Knee and Chest.
Minor Illnesses and Disorders 133
Symptoms and General Treatment in Relation to the
More Common Disorders.
Emergencies and First Aid Treatment 140
Methods of First Aid Treatment Applied to Common
Emergencies. Fainting — Fractures — Hemorrhages
— Poisoning, Etc.
Kinds. Materials Used. Principles of Applying
Bandages in General and for Special Purposes.
Entertainment of Patient 180
Suggestions as to Common Sense Methods of En-
tertaining Convalescents. Suitable Occupations for
Adults and Children.
The Care of Children 186
The Needs of Children. Special Care of Newly
Born Infants. General Care of Small Children —
Nursery — Methods of Bathing. Forming Habits.
General Principles of Infant Feeding — Process of
Modifying Milk — Formulas.
Special Consideration of the Needs of Sick Chil-
dren. Diet. Methods of Restraining. Symptoms and
Treatment of the More Common Illnesses. Care in
Care of Sick Children
Suggestions for Thought in the Nursing of the Sick.
LIST OF PLATES
Patient drinking through glass feeding tube 28
A comfortable arrangement of pillows. Upper bed clothes
folded back 66
Patient sitting up, reading in bed 72
Attendants in position to move patient up in bed ... 74
Drawing patient up from pillow 76
Foot bath in bed. Blanket turned back to show tub ... 86
Applying hot or cold compresses to the eye 114
Sling for arm
Roller bandage for broken collar-bonej
Roller bandage to cover one eye]
Roller bandage for the ear
Recurrent bandage for the scalp ")
Roller bandage for sprained anklej
Method of restraining the arms 196
Method of restraint 198
LIST OF DIAGRAMS
The Human Skeleton 2
Lungs and Air Passages 11
Alimentary Canal 22
Triangular Bandage 161
Four-tailed Bandage 162
Triangular Bandage Folded 164
Spiral Bandage 165
Spiral Keverse Bandage 165
Figure of Eight Bandage 165
PRACTICAL HOME NURSING
THE STEUCTUEE OF THE BODY
The Nervous System
Origin of the body. Life originates from one cell.
This divides into two, each successive cell subdividing
until numerous ones are formed. Cells of a like kind
unite to make tissue. Tissues of a similar kind unite and
form larger units, such as muscular tissue, blood tissue
and fluids which in turn combine to form organs, muscle
The skeleton serves as the foundation of the body and
gives it form. It is also a means of attachment for the
soft parts, and acts as a protection to the vital organs. It
consists of 206 distinct bones which are held together at
the joints by ligaments.
The bone substance is composed of animal matter which
is hardened by being mixed with salts, principally salts of
lime. In children, the bones are softer than in older
people because they contain less earthy salts and more
animal matter. Therefore the older the person the more
brittle the bones become and the more liable to break.
Enveloping the bone is the membrane called the peri-
osteum which protects and nourishes it and is very sensi-
tive when injured.
The Human Skeleton
THE STRUCTURE OF THE BODY 3
TABLE OF BONES
Cranium or Head 8
Hyoid — supporting tongue 1
Trunk of Body
Sternum or chest bone 1
Vertebrae or backbone 26
Clavicle or collar bone 1
Scapula or shoulder blade 1
Humerus or arm 1
££" } F ™ ::::::::: !
Carpus or wrist bones 8
Metacarpus or hand bones ... 5
Phalanges or finger bones ... 14
32 x 2 = 64
Hip bone 1
Femur or thigh-bone 1
Patella or knee-cap 1
Tibia 1 L 1
Fibula J 1
Tarsus — ankle 7
Metatarsus — foot 5
Phalanges or toe bones 14
32x2 = 62
Four varieties of bone comprise the human skeleton:
Long : — serve to support the weight and act as levers :
Example : — legs, arms.
4 PRACTICAL HOME NURSING
Flat : — for protection and to provide a broad surface for
Example : — Ribs and sternum.
Short : — for strength and compactness.
Example : — wrist and ankle.
Irregular: — lack definite shape and so are not to be clas-
sified with the others.
Example : — vertebrae.
CAVITIES AND ORGANS
Spinal canal Spinal cord
Thoracic or chest . . . Lungs, Heart, Trachea, Aesoph-
The Diaphragm muscle separates the thoracic ab-
* Abdominal Stomach, Liver, Pancreas, Small
and Large Intestines, Spleen,
Pelvic Some of the Generative Organs,
Bladder and Rectum.
There are also small cavities such as the mouth, nose, eye,
Note: Position of organs in the abdominal cavity.
The stomach is situated in the upper part, to the center
The liver is in the right hand upper part below the
The spleen is in the upper, left-hand part below the
The kidneys are at the small of the back on either side
of the spine, about the waist line.
The pancreas is behind the stomach.
The small intestines are in the lower part of the cavity.
THE STRUCTURE OF THE BODY 5
The large intestines nearly surround the small intestines.
The appendix is at the point where the small and large
intestines meet on lower right hand side.
A gland is an organ which has the power to abstract
from the blood certain materials and convert them into a
A joint is the point of union of two bones. The ends
of the bone at all such points are covered with a smooth
substance called cartilage, which helps them to glide easily
one against the other, and at all joints the synovial fluid
is secreted which lubricates them and allows movement
without friction. The ends of the bones are held together
Ligaments are strong bands of fibrous tissue attached
to the bones on either side of a joint. They are tough and
inelastic though, at the same time, very flexible thereby
allowing motion of the joints while holding them closely
Muscular tissue commonly called the flesh of the body
is composed of small fibers united in a sheath-covering, and
bundles of these bound together form the different muscles.
They hold the bones together and serve to give shape and
power of motion to the body. Muscle has the power of
shortening in length and increasing in thickness, and upon
this all motion depends.
When a muscle contracts, its two ends and whatever is
fastened to these two ends, are brought together. In this
way the bones of the body are made to move, and for every
muscle that acts upon a limb from one direction, there is
another muscle with a directly opposite action.
PRACTICAL HOME NURSING
Examples of the uses of muscles are :
Facial expression Peristaltic action.
There are two varieties of muscles :
Voluntary, or those that can be made to act by the power
of the will, and
Involuntary, or those acting independently of the will
and without one being conscious of them.
The action of the voluntary muscles is made possible
through the nerves as each muscle is in communication
with the brain or spinal cord through a separate nerve
Tendons are small, glistening cords of fibrous tissue
which attach muscle to bone. A cut tendon is always seri-
ous because it deprives the attached muscle of its power
to move the bone.
Connective tissue is a network of fibrous tissue with
fat cells imbedded in it, and this surrounds the muscles
The skin forms the outer covering and protection of the
body. Its chief uses are :
First — as a covering for the body.
Second — as a heat regulator, by evaporation of per-
spiration on the surface.
Third — as a waste remover, through the sweat glands.
Fourth — as a special organ for the sense of touch.
It consists of an external layer called the epidermis or
scarf skin and an internal layer called the derma or true
THE STRUCTURE OF THE BODY 7
The derma consists of a fibrous substance in which are
imbedded nerves, blood vessels, sweat glands and sebaceous
or oil glands, while upon its surface are a number of small,
highly sensitive projections. Each one of these has a tiny
nerve which ends in it, and the sense of touch lies here.
The sweat glands have the function of separating w T aste
material from the blood in the form of perspiration, which
passes from the glands to the surface by means of ducts
The hair and nails are appendages of the skin.
At the edge of the openings leading into the body, the
skin ends and is replaced with soft, reddish tissue, the
mucous membrane, which forms a smooth lining for the
interior of all bodily tracts. Its surface is lubricated by a
secretion called mucus. This membrane is very absorb-
ent and sensitive to infection.
This is a thin tissue lining some of the cavities of the
body and covering its organs, as for example :
Around the lungs, where it is called the pleura,
Around the intestines, where it is called the peritoneum,
Around the heart, where it is called the pericardium.
This membrane secretes a fluid to moisten its surfaces.
THE NERVOUS SYSTEM
The nervous system is a chain of nerve cells in close
relation to each other and extending by branching nerve
fibers to all parts of the body.
The brain, which is enclosed in the skull, is the central
power, and the spinal cord (protected by the strong bones
of the vertebrae or backbone) acts in alliance with the
brain, and from these centers all nerves branch.
The nerves control the muscles and in case there is pres-
PRACTICAL HOME NURSING
sure from any cause ou a nerve, the muscle controlled by
it is weakened or paralyzed until the pressure is removed,
after which it may regain its power by gradually increased
The nervous and physical systems affect one another
closely, so that in nursing the sick, special care should be
taken not to overtire or over-excite the nervous system be-
cause of its effect on the physical condition, nor to overtax
the physical strength because of its effect upon the nerves.
Reaction from nerve strain usually means physical ex-
haustion and the best remedies are rest, quiet, sleep, and,
if possible, diversion from the cause of the nerve strain.
What elements in food supply bone with nourishment ?
Name bones of the upper extremity.
Name bones of the lower extremity.
Describe the clavicle.
What bones form the pelvic cavity ?
Where is the diaphragm and what is its function ?
Describe the formation of a joint.
What are the functions of muscles ?
Name the organs of chest and abdominal cavities.
Describe the skin.
What is the central force of the nervous system ?
What organs do the nerves most directly control ?
How may nerve strain be prevented ?
CIRCULATION OF THE BLOOD
Respiration — Pulse — Temperature
Blood. Blood, the vital fluid of the body, is composed
of red and white corpuscles or little solid bodies floating in
a serum. It is the medium for conveying both oxygen
from the air and the product of food to the tissues of the
body to give nourishment and to create heat and energy.
This oxygen is derived from contact of the blood with air
iu the lungs and the product of food (after the comple-
tion of the process of digestion and absorption), is con-
veyed directly into the blood circulation. Blood also
has the power of collecting waste from the tissues and
bringing it to the lungs to be breathed out from the body.
Blood tests. Blood tests are made by a physician to
determine the condition of the blood by analysis. One
method is to prick either the ear or the tip of the finger
and obtain blood in that way ; another is to have the blood
drawn directly from a vein. In either case, the surface
of the skin should be disinfected with alcohol, or painted
over with iodine before the physician draws the blood
from the part.
Blood pressure. By blood pressure is meant the pres-
sure exerted by the blood on the walls of the vessels in
which it is flowing.
CIRCULATION OF THE BLOOD
Circulation is the conveying of the blood through the
body by means of the heart and three kinds of blood vessels.
The heart is a hollow muscular organ about five inches
long, placed in the center and left of the chest cavity. The
10 PRACTICAL HOME NURSING
left side of the heart which always contains arterial or pure
blood, is completely separated from the right side which
contains venous or impure blood. Each side is divided
into two parts ; an auricle and a ventricle, with a valve be-
tween. The heart is provided with a covering called the
Arteries are the vessels which carry pure bright blood
from the left side of the heart through the body.
Veins are the vessels which bring the dark, impure
blood back to the right side of the heart. They are pro-
vided with valves which prevent mixing of the impure with
the pure blood.
Capillaries connect the arteries and veins. They are
very minute and almost porous vessels and during the time
the blood passes through them it gives off vitality and nour-
ishment to the tissues and absorbs impurities from the
Circulation is carried on as follows : the contraction of
the heart forces the blood from the left side into the aorta,
the largest artery in the body, and then to smaller and
smaller arteries until it reaches the capillaries. After
circulating there, it goes first into the small and then into
the larger veins, until finally the two largest veins of the
body, the superior and inferior vena cava, bring the
blood to the right side of the heart. It is then carried to
the lungs through the pulmonary artery, (this is the only
artery that carries impure blood), to be purified by coming
in contact with oxygen from the air, and by giving off im-
purities to be breathed out. The pulmonary veins (the
only veins that carry pure blood) take it back to the left
side of the heart.
THE LYMPHATIC SYSTEM
The lymphatics are an extensive network of small ves-
sels distributed generally through the body, and contain a
fluid called lymph. They are often spoken of as absorb-
CIRCULATION OF THE BLOOD 11
ents as they absorb certain elements from the blood and
distribute them to the tissues ; they also absorb waste from
the tissues and convey it to the blood to be sent out of the
Respiration is the act of breathing. The organs con-
nected with this process are : nose, mouth, trachea, lungs.
There are two lungs, one on either side of the chest cav-
LUNGS AND AlK-PASSAGES.
a, larynx; 6, trachea;
c, bronchial tubes.
ity, each with its own covering called the pleura. The
lungs are composed of a sponge-like substance made of air
cells and blood vessels. They communicate with the outer
air by means of the trachea which subdivides on reaching
the lungs and forms the bronchial tubes in each lung.
The larynx is the opening from the mouth to the
trachea and is provided with a small lid-like covering
which closes during the act of swallowing and prevents
food being carried into the trachea.
Respiration consists of two parts, inspiration — or
12 PRACTICAL HOME NURSING
drawing the air in, and expiration — or driving the air
out — but the lungs are never entirely emptied. A large
percentage of oxygen is breathed in from fresh air which,
mixing with the blood, purifies it; and in the circulation
of the blood, this oxygen is conveyed to the tissues. A
large percentage of carbon dioxide is breathed out, thus
removing waste from the body which has been gathered
from the tissues in the circulation of the blood. The ex-
haled air is always the temperature of the body and in
this way a certain amount of heat and moisture is con-
stantly being lost and the body cooled off.
Counting respiration. Observe the rise and fall of
the chest (which constitutes one breath) and count for a
full minute, or for half a minute and double the number.
It is better to count this immediately after taking the
pulse and while the hand is still on the wrist as the breath-
ing is more natural when the patient is not conscious of its
being counted. There is usually about one respiration to
four heart beats.
Table of Respiration
Normal 18 per minute
Limits of normal . . . 16-22 per minute
Fast 30 per minute
Very fast 40 per minute and up
Points to notice about respiration :
Its regularity — or irregularity ;
Is it quiet, labored, or noisy ?
Note : See emergencies for artificial respiration.
Pulse indicates the heart beat. When the heart con-
tracts, it forces the blood into the arteries, and whenever
an artery approaches the surface, the pulse can be felt.
CIRCULATION OF THE BLOOD 13
This is usually counted at the radial artery on the thumb
side of the wrist ; also at the temporal artery on the lower
side of the forehead, or at the femoral artery in the groin.
Method of counting. If taking the pulse at the radial
artery, have the arm extended and resting on some sup-
port; make slight pressure on the artery with the index
and middle finger, and count by tens for a full minute,
dividing the count at the half minute to compare the fre-
quency of the beat with the next half minute.
Another method is to count for a half minute and
double the number.
Easy method of counting pulse:
1, 2, 3, 4, 5, 6, 7, 8, 9,-10
1, 2, 3, 4, 5, 6, 7, 8, 9 — 20
1, 2, 3, 4, 5, 6, 7, 8, 9,— 30— and so on.
Table of Pulse
In adults :
Normal 72 per minute
Limits of normal .... 60-80 per minute
Eapid 100-120 per minute
Very rapid 130-140 per minute and up
In children :
Infancy — at birth . . 130-140
First two years, about 120-110 (at end of second
2d to 5th years 10*0-90
5th to 12th years 90-80
It is generally found that a man's pulse beats more
slowly than a woman's.
During sleep the pulse rate is slower.
Some points to observe regarding pulse are whether it is :
fast or slow*,
PRACTICAL HOME NURSING
regular or irregular or intermittent,
strong or feeble.
Some causes that hasten pulse are:
Pulse beats faster when a person is in a standing posi-
tion, and slower when lying down, so whenever it is neces-
sary to save a strain on the heart, keep the patient lying
down, or, if necessary to raise a patient who has a weak
pulse — do it with a steady, slow movement. There
never is an increase of temperature without an increase
of pulse, usually at the rate of ten beats for the rise of
each degree of temperature, but there can be an increase
of pulse-rate without a rise of temperature.
Temperature is the heat of the body. The blood keeps
the body warm and the action of the skin, by the evapora-
tion of the watery part of perspiration, keeps the heat
from accumulating. This is aided by the accumulation
and loss of heat in the act of breathing, and also by the
loss of heat in the fluids eliminated from the body. Thus
a normal temperature is maintained in health.
Rise of temperature is caused either by overproduc-
tion or by imperfect loss of heat. Change of temperature
may be the first symptom of disorder and should be care-
Table of Temperature
Limits of normal
100 — up°
CIRCULATION OF THE BLOOD
High fever . . . .
Very high fever
Temperature of the body is lowest between midnight
and 5 a. m. It is highest between 5 a. m. and 10 p. m.
In convalescence, a patient is likely to have a subnormal
temperature in the morning for some time, owing to lack
Taking temperature of the body. The heat of the
body is gauged by taking the temperature with a clinical
thermometer which differs from the ordinary thermometer
by remaining at the point reached until shaken down and
it has a range only from 94-110 degrees. To shake the
mercury down, place the stem of the thermometer between
the first and second fingers with the bulb downward and
hold it with the thumb, and give the hand a sharp jerk.
In all cases before taking the temperature, the ther-
mometer should be cleansed with water or alcohol and the
mercury shaken down to 96°.
The temperature may be taken by mouth, rectum or
axilla (under the arm).
Methods of taking temperature. By mouth.
Place the bulb of the thermometer under the patient's
tongue, touching the mucous membrane of the mouth,
and keep it there from 2-3 minutes, having the lips
closed during this time. Remove from the mouth, read
and record the temperature. Nothing hot or cold should
have been taken into the mouth for at least ten minutes
By rectum. This method is the most accurate and
usually records a temperature one degree higher than by
mouth. It is used for children, very sick people or in
cases where the mouth cannot be kept closed. Oil the
PRACTICAL HOME NURSING
bulb of the thermometer and insert about 2 inches into the
rectum and hold in place for 2 or 3 minutes.
By axilla. Place the bulb of the thermometer in the
hollow under the arm, touching the skin, and hold the arm
over the body. Keep the thermometer there for 5 min-
utes. This will register about a degree lower than by
To disinfect a thermometer wash it in soap and water,
not hotter than 105°, then in alcohol.
To test a thermometer, place it with another in warm
water at a temperature of 105° and see if both reach the
same point at the end of two minutes.
If a thermometer should be broken while in the mouth,
have the patient immediately rinse out the mouth thor-
oughly to remove broken glass and mercury, and give olive
oil at once.
To reduce fever without medicine. Ma^e the skin
act by bathing with tepid or cold baths, keeping cold to
the head. Have the patient in a cool room, under light
covering, with fresh air and plenty of fluid to drink.
Also give a very light diet and provide for a free action
from the intestines.
To raise the temperature. Apply heat, either hot
water bottles or bags (covered), taking care not to burn the
patient, or hot blankets wrapped closely around patient;
hot drinks — such as ginger tea, coffee, tea or alcohol (of
the latter a tablespoonful of whiskey in a little hot water).
Keep the patient lying down to save the heart action.
CIRCULATION OF THE BLOOD 17
By what means is circulation carried on ?
Describe the heart.
Trace the circulation of the blood from the left side of the
heart back to the same point.
What are the functions of the capillaries?
What is the difference between arteries and veins ?
Name the largest artery — largest veins.
Describe the lymphatics.
In what direction does the blood in veins flow ?
What are the respiratory organs ?
Describe the lungs.
How is waste of body removed by the lungs ?
How many heart beats to one respiration ?
How does air reach the lungs ?
What is normal respiration for adult ?
Give rate of normal pulse in adult — in child.
How is the pulse affected by rise of temperature ?
Mention causes that decrease the pulse rate.
Where can the pulse be counted ?
Mention causes that increase the pulse rate.
What keeps the temperature of the body normal ?
From what is the heat of the blood derived ?
Give normal temperature for adult.
How reduce fever without medicine?
How raise a subnormal temperature ?
Describe methods of taking temperature.
THE URINARY TRACT
Urine is the principal waste matter of the body and is
separated from the blood by the kidneys and carried out
of the system through the urinary tract. Its chief solid
constituent is called urea and it also contains a large pro-
portion of water — about 95 per cent. — and uric acid, col-
oring matter and salts.
The kidneys are two small, bean-shaped organs, about
four inches long by 2y 2 inches wide, situated in the small
of the back on either side of the spine at the waist line.
The urine passes from them to the bladder through two
narrow tubes, 12 to 18 inches long, called ureters.
The bladder is in the lowest part of the abdomen, at
the front of the pelvic cavity and acts as a reservoir for
the urine. It has a capacity of about one pint. The
urine passes from this through a small, muscular tube
called the urethra to the meatus, or mouth. In the fe-
male, the urethra is iy 2 inches long.
It is very necessary that the kidneys be unimpeded in
their chief work — that of carrying off the urea, — lest this
waste matter be carried back by the blood and poison the
The normal amount of urine passed by an average
healthy adult in 24 hours is about 3 pints, and the color
should be light amber. But the amount passed may be
temporarily increased or decreased by various causes, in
health as well as in sickness. The amount may be in-
creased by drinking a quantity of fluid, by lessened per-
spiration or by emotion ; and usually when more is passed,
THE URINARY TRACT
its color is lighter. The amount may be decreased when
less fluid is taken into the system, when the skin perspires
freely and, usually, when a person is suffering from fever
or from some form of kidney disease.
Always observe any change in the color, quantity and
frequency in passing of the urine as this often points to
conditions in the system which might otherwise pass un-
noticed. Also note if there is any distress in passing it.
Suppression of urine is caused by the kidneys failing
Retention of urine is caused by the failure of the blad-
der to expel its contents.
Incontinence is the failure of the bladder to retain its
Plenty of water should be given to sick people, par-
ticularly in cases of fever and when changing from a
fluid to a solid diet.
Difficulty in passing urine. There is frequently
some difficulty in passing urine from the bladder. This
may be either from weakness of the urethra, or contraction
of the muscles, and in such a case the patient may be
helped to expel the urine by some of the following aids :
(1) if allowable, raise the patient to a sitting position;
(2) apply heat over the bladder or between the thighs, or
put hot water in the bed pan; (3) give a hot drink; (4)
give a hot, simple enema; or (5) if the patient is nervous,
go out of the room and leave her alone. If necessary to
use any further treatment, a doctor should be consulted.
Report if the patient cannot pass urine at the end of 12
hours. At any time, if doubtful of a sufficient amount of
urine being passed, measure it in a graduated measuring
glass or some substitute.
Specimen of urine. To secure a specimen of urine
20 PRACTICAL HOME NURSING
for analysis. First, wash off the part and then have the
patient pass urine into an absolutely clean vessel. From
that amount, take 8 ounces and place in a sterile (boiled)
bottle, cork, and label with patient's name and send imme-
diately for analysis.
If a 24-hour specimen is wanted, keep in a clean bottle
or vessel, and collect all the urine passed in 24 hours. To
secure this accurately, have the patient empty the bladder
at 9 a. m., for instance. Do not count that at all, but
start the record from that hour and keep it until 9 a. m.
the next day.
Define urine and state from what it is derived.
Describe the kidneys and state their function.
What is the position of the bladder ?
What is the function and what the capacity of the bladder ?
State the normal amount of urine passed in 24 hours.
How relieve retention of urine ?
How relieve suppression of urine?
Describe method of securing a 24-hour specimen.
Name the constituents of normal urine.
THE DIGESTIVE TRACT
The Process of Digestion — The Food Principles — Diet
The digestive tract is known as the alimentary canal
which is about 28 feet long and divided into different
The digestive process all takes place in the alimentary
The liver and pancreas are accessory organs which
send their juices into the small intestines. (See digestive
Digestion is a mechanical and chemical process by
which foods are changed to prepare them for absorption
by the tissues. The mechanical part is largely mastica-
tion by the teeth and the action of the muscles throughout
the different parts of the tract; the chemical part is the
effect produced on the food by the different digestive
Absorption is the taking up of food into the tissues
when digested, and making it into a suitable solution for
absorption by the blood.
Peristaltic action is the movement made by the con-
traction and relaxation of the muscles of the stomach and
Large intestine (which
ends in the rectum)
22 PRACTICAL HOME NURSING
Stomach Gastric juice
Intestine Intestinal juice
Pancreas Pancreatic juice
FUNCTION OF THE DIGESTIVE ORGANS
Mouth. The functions of the mouth are to secrete the
saliva in the salivary glands (this chemically affects cer-
tain food elements), and to masticate and make food more
Stomach. The stomach secretes the gastric juice in
6. Bile duct,
p. Pancreatic duct.
THE DIGESTIVE TRACT
its glands, (this chemically affects certain food elements).
It makes food soluble, assists in digestion and has some
power of absorption.
The liver. The liver secretes the bile, stores it in the
gall bladder, and from there it is sent through a duct as
needed to the small intestines to assist in digestion. The
bile also serves as an antiseptic to the intestines.
The pancreas. The pancreas secretes the pancreatic
juice and from there it is sent through a duct to the small
intestines to act as a digestive juice in chemically affecting
Small intestines. The functions of the small intes-
tines are to secrete intestinal juice (which chemically af-
fects food), to receive the bile and pancreatic juice, to
finish the digestive process of all food not previously di-
gested, and to absorb most of the product of food.
Large intestine. The function of the large intestine
is to absorb some of the product of food, particularly
fluids, and to pass the residue on and out of the body
through the rectum.
FOOD AND THE DIGESTIVE PROCESS
Food is a substance essential to the body and com-
bined with oxygen in the air makes the motive power that
sustains life. Food contains the chemical elements sim-
ilar to those found in the composition of the body and
after the process of digestion has taken place, the product
of food is in a condition to replenish or build up these
tissues and become part of them. The combination of
food with the oxygen of the air causes combustion which
creates the heat and energy in the body necessary for work
or activity of any kind. A proper proportion of all classes
of food is required to maintain health.
Food adjuncts, such as flavoring, spices, etc., have no
nutritive value but they stimulate the appetite and help
make variety in the taste of food.
PRACTICAL HOME NURSING
THE FIVE FOOD PRINCIPLES
Lean of meat,
Albumen of fish,
Curd of milk,
Gluten of bread,
Cream, fat of meat,
To build up and
lime (in many
In all foods.
To yield heat,
Build up fat
To yield heat,
Store up fat
To build up bone
and other tis-
sues and keep
As a solvent and to
form part of all
Food may be classified chemically as :
Organic — Proteins, fats, carbohydrates.
Inorganic — Mineral salts and water.
It may also be classified as :
Nitrogenous (meaning proteins).
Non-nitrogenous (meaning all other classes of
In regard to their source, foods are divided into
Animal (and this includes their products),
THE DIGESTIVE TRACT
PROCESS OF DIGESTION OF FOOD
The mouth. In a mixed diet, all food is first made
partly soluble iu the mouth by being chewed with the
teeth and mixed with the saliva (the digestive juice of
the mouth), and the starches are changed into sugar by the
chemical action of the saliva upon them.
The aesophagus. The food, after being swallowed,
progresses through a tube called the aesophagus to the
The stomach. In the stomach all food is made soluble
and changed by being mixed with the Gastric juice com-
bined with the muscular action of the stomach, and the
digestion of the proteins is largely affected by the chemi-
cal action of the gastric juice. The semi-solid substance
which represents food after the changes in the stomach
have occurred is known as Chyme.
Small intestines. The food then passes to the small
intestines and comes in contact with three juices:
Bile, from the liver ;
Pancreatic juice, from the pancreas ;
Intestinal juices, secreted in the small intestines.
The fats, which have not previously been affected to any
extent, are here digested ; the digestion of all food is here
completed, and absorption of the food products follow.
The milk, like fluid which represents food after undergoing
the process of digestion in the intestines is known as
Large intestine. The absorption of some of this food
and also of most of the fluids taken into the body continues
all the way down the large intestine, and what is not ab-
sorbed, passes off out of the rectum as waste or fecal mat-
ter. In all food there is meant to be a certain amount of
waste or bulk which is not absorbed and when this reaches
PRACTICAL HOME NURSING
the large intestine, it stimulates the muscular action there
and prevents an accumulation of residue which, if too long
in the intestines, may cause a reabsorption of it into the
system with bad results to the general health.
A diet comprising all five elements of food is best in
health and as far as possible in time of sickness, but in
the latter case sometimes a restriction or an elimination of
one class of food is ordered because it cannot be digested
and assimilated properly in the system under the existing
conditions of the illness. To diet a person in any case is
to prevent elements of food being put into the body which
cannot be taken care of there.
Diet in disease. The principles governing diet in dis-
ease are :
(1) To give as much nourishment of the right kind as
can be assimilated and at the same time try to provide suf-
ficient bulk to stimulate the intestines to act normally:
(2) To give a sufficient amount of water;
(3) To restrict or eliminate any one class of food, the
waste of which cannot be thrown off through the channels
by which waste is usually removed from the body ;
(4) To restrict foods which are causes of irritation to
the system in general or, to any one organ in particular,
such as the stomach, kidneys, intestines, etc.
(5) To restrict elements which cause undue acidity.
In acute diseases the diet is usually ordered by the physi-
cian, while in convalescence and simple cases of illness
it is left more to the judgment of those taking care of
the patient. A highly condensed protein food and cereals
reduced to flour are rather constipating, while fats, coarse-
grained cereals, bread, green vegetables and fruit, tend to
In time of illness, food is generally given at shorter in-
tervals, in smaller quantities, and in more condensed form
THE DIGESTIVE TRACT
than in health, and the heaviest meal is served in the
middle of the day.
Amount. The amount is sometimes regulated by order,
but as a general rule it is better to offer too little rather
than too much, especially in trying to tempt the appetite.
If the amount is estimated in calories (a calory being
a heat unit or measure of heat) it means that a sufficient
allowance of certain elements in food is made to supply
the necessary heat and energy used up by the body.
Care of food. Food for an invalid particularly must
always be pure, fresh and clean, and, as bacteria easily
develops in it, should be kept covered and cold. Meat, fish
and milk are particularly susceptible to decomposition.
Choice and preparation of food. The value of food
that can be easily digested and assimilated is a very im-
portant factor in reestablishing health. It should be pre-
pared and served in such a way as will tempt the appetite
by appealing to the sense of taste and sight, and meeting
the personal desires of the patient as far as practical.
Varying the diet. Make food interesting to the
patient by varying the diet as much as is allowable under
the circumstances of the illness. Also vary the way of
cooking the same articles of food and serve in dainty, un-
expected ways. Even bread can be of different kinds and
varied in the way it is cut and arranged. If the patient
has a persistent craving for something which can do him
no actual harm this craving should be satisfied if possible,
as the monotony of diet is trying to a patient.
Serving food. Meal times are important events to a
patient, affording as they do an opportunity to make a
break in the monotony of the sick room, and should be made
cheerful and agreeable. Before serving a meal have the
patient rinse out the mouth and arrange her in a com-
fortable position with the head and neck supported by
pillows, and the tray placed conveniently either on an
28 PRACTICAL HOME NURSING
improvised stand or upon a bed table stretched across the
bed and adjusted to the proper height, or on a bed tray.
A substitute for the latter can be made with a board resting
on supports on either side of the patient to keep the weight
off the knees.
Arranging tray. Arrange the tray in an attractive
manner and to look like a well set place at a table, not too
crowded, the linen clean, the silver bright, and as dainty
china as can be obtained, if possible with a colour scheme
in the dishes. Well selected flowers add an interest.
Serve cold foods cold and hot foods hot. Heat cups
meant to contain hot fluids beforehand, and serve hot food
on a hot water plate, which is a china plate set over an
aluminum deep dish fitted with a spout and screw top in
which boiling water can be placed to keep the food hot on
the plate. This can be substituted by a heated plate
placed over a bowl of very hot water.
Feeding a helpless patient. In feeding a helpless pa-
tient, allow plenty of time so that there may seem no neces-
sity for hurrying. Support the head at a convenient
angle on the pillow, not bending it too far forward. Place
the food on the tongue and not just inside the lips. If a
patient is able to drink fluid, have the glass only about two-
thirds full (so as not to spill it) or use an invalid's cup
with a partial cover. Another method is to use a bent
glass tube with one end in the fluid. The glass containing
the fluid can most conveniently be placed in the hollow of
the patient's arm so that the tube may reach the mouth
easily. As a substitute for the glass tube, a straw or a
piece of clean rubber tubing with a glass tip may be used.
CLASSES OF FOOD
In regard to its source, food is divided into animal,
vegetable and mineral, while water exists in all foods.
THE DIGESTIVE TRACT
About two-thirds of the body consists of water. A
certain amount of water independent of the fluid contained
in food is essential in illness as well as in health, (1) to
flush out the system, (2) to remove worn-out tissue and
(3) to assist in assimilating food. At least two quarts
of liquid in some form should be taken as the minimum
amount in twenty-four hours, some of which is included
in beverages with food.
Under ordinary circumstances the available drinking
water is considered pure though it should be filtered.
Where possible its source should be carefully investigated
and if there is the slightest doubt as to its purity, particu-
larly in times of epidemics, it should be boiled to destroy
any harmful bacteria in it. In order to avoid the flat
taste, consequent to boiling, it may be boiled for only two
minutes, then shaken from one vessel to another to re-aer-
ate it. Water can also be purified by being sterilized in
the upper part of a double boiler, the water in the lower
part of which should be kept boiling for an hour.
A great deal of water is given in the form of beverages
such as orangeade, lemonade, tea, etc., which may appeal
more to the patient than plain water. It is -sometimes
ordered in the form of alkaline mineral, or charged water,
such as vichy.
What is known as " hard " water generally contains a
great deal of mineral deposit and this is constipating.
This hardness can be corrected by boiling which tends to
cause the mineral salts to settle in a deposit, or bicarbonate
of soda can be added to soften hard water.
Ice. As freezing does not destroy all germs and only
renders some of them temporarily inactive it is important
to have ice come from pure water. If the water for arti-
ficial ice is pure that will be quite safe to use. All ice
should be washed before being placed in the ice box. This
box requires to be kept thoroughly clean as particles of
PRACTICAL HOME NURSING
food, combined with the melting ice, accumulate in the
piping where bacteria may develop. This piping can be
cleaned with boiling hot soda and water to dissolve any
grease that may have been deposited there.
Animal food is used in the forms of flesh of animals,
fowls and fish, and in the juices extracted from them and
also their products such as eggs, milk, etc.
Milk. Milk is largely used in the food of invalids as
it can usually be changed, if necessary, to suit the diges-
tion of the individual patient, can be easily taken, is a
good medium for other food and in itself contains all of
the food elements in the following proportions:
Water ..8 7 per cent. Fat 4 per cent
Protein . 3.3 per cent. Carbohydrate. . 5 per cent.
Mineral . .07 per cent.
The fats and sugars are in a particularly digestible form
and the mineral salts in good proportion. The curd of
milk, or the protein, is less digestible in proportion to the
other constituents and the milk has often to be changed on
this account to suit a patient's needs.
Milk should always be taken slowly so that the curds
formed in the process of digestion (which solidifies the
curd first) will not become too large and cause distress, by
preventing the gastric juice acting on them.
The amount of water in milk is sometimes considered
a disadvantage on account of its bulk.
It is essential that milk should be pure and kept cov-
ered and cold as it absorbs bacteria very easily particu-
larly between the temperature of 70° and 100°.
Methods of purifying milk.
Pasteurizing — which means mantaining a heat of
140° for half an hour to destroy most harm-
THE DIGESTIVE TRACT 31
Sterilizing — means a heat of 212° from /4 to 1
hour and destroys all germs.
Scalding — at a temperature of 180° destroys
germs that cause fermentation or souring.
(See method for above on page 36.)
Suggestions for altering the conditions in milk to suit
the individual needs of a patient:
Milk with lime water
Milk with soda
Milk with vichy
to counteract too much
Peptonized — predigested milk.
Milk with salt.
Kumyss — a fermented milk (which alters the con-
dition of the curd).
Matzoon or Zoolak — fermented milk.
Buttermilk — containing less curd and sugar and
more fat than skimmed milk.
Whey — containing little nourishment but easily di-
gested and slightly acid in taste.
Milk added to bread or cereal aids its digestion by
preventing too large curds being formed.
Junket and some custards serve as milk substitutes.
Milk diet. A diet entirely of milk is sometimes or-
dered in an amount varying from 6 to 8 ounces at inter-
vals of two or three hours. The following are suggestions
for varying a milk diet :
PRACTICAL HOME NURSING
r Dried milk
Hot milk (not boiled) Oval tine \ Cocoa
Cool milk L Cereal
Buttermilk Malted milk
Matzoon or Zoolak Condensed milk
Fermilac Milk flavored with coffee,
Ice cream nutmeg, chocolate, etc.
Egg-nog Albumenized milk
Milk 2 parts, club soda 1 Milk toast
part Milk and gruel (barley and
Eggs. Eggs contain all the food elements except car-
bohydrates and are usually taken in combination with
them. They are considered especially valuable as con-
taining nourishing elements in a condensed form and are
easily digested under most conditions. The albumen or
white of egg raw, is combined with many beverages and the
entire raw egg is largely used in the diet of invalids. In
order to make cooked eggs easily digestible they must be
cooked at a low temperature to prevent the albumen of
the egg becoming tough. (See page 41.)
The vegetable class of foods consists of the product of
vegetation or plant life, such as grains which supply the
material for bread and cereals, also starch, green vegeta-
bles, fruits, and the various forms of sugar derived from
them, as well as nuts and their derivatives.
Minerals are found in practically all foods in varying
quantities in such forms as iron, lime, phosphorus, etc.,
and a mixed diet provides this in necessary proportions.
EXAMPLES OF DIETS
Liquid diet. This would usually consist of milk, of
broth, beef tea, beef juice, cereal or arrowroot gruel, albu-
men water, orangeade, egg-nog, or other nourishing bever-
THE DIGESTIVE TRACT
Liquid Diet for Twenty-four Hours
7 Hot milk flavored with coffee .... 6-8 ozs.
9.30 Oatmeal gruel with 1 oz cream. .6-8 ozs.
12 Egg-nog 6-8 ozs.
2.30 Beef broth 6-8 ozs.
5 Kumyss 6-8 ozs.
7.30 Chicken broth 6-8 ozs.
10 Hot milk 6-8 ozs.
2 a. m. Hot milk 6-8 ozs.
Soft diet. This includes puree of vegetables, cereals,
rice, jellies, soft cooked eggs, raw scraped beef sandwich,
milk toast, custards, soft puddings, etc.
Breakfast Soft boiled egg, toast, milk with coffee.
10 a. m. Chicken broth.
Luncheon Scraped beef sandwich, baked custarc.
4 p. m. Orange juice.
Supper Cream toast, snow pudding.
10 p. m. Hot milk.
Convalescent diet. This includes the foods men-
tioned above and scraped beef, slightly cooked, baked po-
tato, cooked and raw fruit, green vegetables, oysters, fresh
fish, bacon, squab, sweetbread, chicken, chops, steak, etc.
Breakfast Grape fruit, cream of wheat cereal with
cream, bacon broiled, toast, coffee.
10 a. m. ^Orange juice in ice water for drink.
Dinner Squab, spinach and egg, potato in shell,
ice cream, sponge cake, black coffee.
Supper Baw oysters, brown bread and butter, tea,
blanc mange and cream.
10 p. m. Hot milk.
The change from one form of diet to another should be
PRACTICAL HOME NURSING
gradual both in considering the amount and the variety,
and plenty of water should be given when changing from
a liquid to a solid diet.
Mention the organs connected with the process of digestion.
What are the divisions of the alimentary canal ?
Name the digestive juices.
Define digestion — absorption.
What is meant by peristaltic action ?
What is the danger to patient of an unclean mouth ?
How would you feed a helpless patient ?
How may food become infected ?
Name the food elements.
Mention the functions of each.
What foods stimulate the muscles of the large intestines ?
How could you vary a milk diet ?
Mention methods of changing conditions in milk.
What is the general principle for restricting diet ?
What are uses of water in the body ?
Apart from food, mention conditions that affect digestion.
Symbols : — tbsp. for tablespoon
tsp. for teaspoon
A level spoonful or cupful is meant in all cases.
Juice of 1 lemon or 3 tsp. of sugar
3 tbsp. of lemon juice 1 cup of water or vichy
Dissolve sugar in a little boiling water, add this to the
juice and water and cracked ice.
Albumen can be added.
Juice of 1 orange M> tbsp. of sugar
1 cup of vichy
Dissolve sugar in a little boiliug water, add to juice, and
strain over cracked ice.
Lemon or pineapple juice may be added.
White of 1 egg % cup of water
Place in a covered jar or shaker. Shake thoroughly,
strain and serve. This may be flavored with any fruit
To place cracked ice in the shaker breaks up the albu-
3 tbsp. rice 1 pt. water
Pinch of salt
PRACTICAL HOME NURSING
Soak rice in water 30 mins.
Heat gradually to boiling point and cook 1 hour.
Strain, dilute with boiling water or hot milk and season
with salt. Sugar or flavoring may be added.
2 tbsp. of barley flour to 1 pt. of boiling water
Make flour into a thin smooth paste with cold water.
Add boiling water to it very gradually, stirring rapidly.
Boil over direct heat 5 mins., then cook % hour in a
double boiler, stirring frequently.
Strain through fine gauze strainer while hot.
% cup of cold water 1 pt. cold milk
1 tube Fairchild's peptonized powder
Cold process: Dissolve the powder in the cold water,
add the milk, and place in a bottle and keep on ice.
Warm process: Mix in same manner and keep the bot-
tle surrounded with water at 115 degrees for 10 to 20
minutes, depending on the degree of peptonizing required,
cool quickly and keep on ice or lacking ice after above
process bring quickly to boiling point to stop the action of
To pasteurize a bottle of milk, place it in a vessel of
cold water, with a wire protector under the bottle, and
bring the temperature of the water up to 140 degrees and
keep it at that temperature, or between 140 and 145 for
one-half hour. Cool immediately and keep on ice.
For pasteurizing babies' bottles, a convenient form of
apparatus is the Freeman pasteurizer, in which spaces are
arranged for each bottle and directions for its use are
given with it.
Milk can be pasteurized in the upper part of a double
boiler by using a thermometer and keeping the milk at
the required temperature for % hour. Pasteurized milk
should be used within 24 hours.
Milk can be sterilized in the same manner as above,
except that the temperature must be at boiling point —
212 degrees for % hour. Sterilized milk is supposed to
be safe for 48 hours, but sterilization is destructive to the
value of the milk.
1 pint milk 2 tbsp. sherry wine
1 tsp. sugar
Pour the wine into the warm milk and cook over boiling
water about five minutes, or until the curd separates from
the whey. Strain through fine cheese cloth and sweeten.
Serve hot or cold.
1 pint milk 2 tbsp. lemon juice
2 tsp. sugar
Prepare in the same manner as wine whey.
1 pint milk 2 tsp. rennet
1 tsp. sugar
Heat the milk until lukewarm, add the sugar and stir
until dissolved, add rennet; leave until firm, about 20
minutes. Break the curd and strain through fine cheese-
cloth. Flavor if desired.
1 cup milk V2 tbsp. sugar
1 tbsp. rum or brandy
Place all the ingredients in a covered glass jar, shake
until thoroughly blended.
1 pint boiling water 2 tsp. tea
PRACTICAL HOME NURSING
Heat a small teapot. Place the tea in it and pour
freshly boiling water over it; steep a few minutes and
strain. It may be served hot or cooled and iced, with
lemon or cream.
2 tbsp. coffee Small pieces of egg shell
1 tbsp. cold water 1 pint boiling water
Mix the coffee with the cold water, and shells. Add
boiling water. Boil 1 minute, remove to back of stove.
Add a little cold water to settle it.
2 level tsps. cocoa X A cup water
Sugar to taste 1 cup milk
Mix cocoa and sugar, add the cold water and boil di-
rectly over fire 3 minutes. Then stir into the milk and
cook 5 minutes over hot water.
Toast is bread in which the starch has been changed to
dextrin, which is the most easily digested form of starch.
Cut a slice of stale bread % inch thick, put it on a
toaster and let it gradually dry, then allow it to become a
light brown by placing it nearer the heat. It may be
toasted in the oven.
1 cup hot milk 1 slice toast buttered
Pinch of salt
Dissolve the salt in the hot milk and pour over toast cut
1 tbsp. butter 1 cup of milk or cream
1 tbsp. flour Pinch of salt
2 slices of toast
Heat butter, add flour and salt, stirring until thoroughly
blended. Add the milk gradually, bring it to a boil, and
boil for two minutes. Pour over the toast and serve.
Corn meal gruel
1 tbsp. com meal 1 pt. water
Pinch of salt
Sprinkle meal into the boiling salted water, cook over
direct fire 10 minutes, stirring constantly, then over boil-
ing water 1 hour. Add cream and serve.
Oatmeal flour gruel
2 tbsp. oatmeal flour _ 1 pt. water
Pinch of salt
Mix flour in cold water and stir into boiling water,
cook 5 minutes over direct fire, then continue over boil-
ing water in a double boiler % hour. Strain and flavor to
1 tbsp. sifted cracker 1 cup hot milk
crumbs Pinch of salt
Sweetening to taste
Pour hot milk gradually on to cracker crumbs, stirring
constantly. Cook in double boiler five minutes.
1 tbsp. rice 1 qt. milk
Salt to taste
Parch the uncooked rice deep golden color in a clean,
dry frying pan, shaking and stirring all the time. Add 1
qt. of milk with a pinch of salt and put in a double
boiler and cook till reduced to about half the quantity or
until the mixture is creamy. Cool and put on ice. Can
be served hot or cold.
Rice boiled and steamed (Southern)
Take 1 cup of rice and sprinkle into a large saucepan
half full of boiling salted water, boil 15 to 20 minutes
until slightly soft, then strain into a colander and rinse off
with cold water. Leave rice in the colander and place
PRACTICAL HOME NURSING
over boiling water, cover and steam % hour. Each grain
will be whole, dry and tender.
1 lb. beef makes 1 pt. beef tea
Chop 1 lb. beef very fine, place in upper part of double
boiler and cover with cold water. Soak for 2 hours, then
place upper part of double boiler over cold water on the
fire, which gradually heats. Stir frequently and when
the beef tea is a reddish-brown, pour off and season, re-
moving fat. This may be served hot or cold.
1 lb. beef makes 4-6 ozs. of beef juice
Take 1 lb. of beef and sear over the fire or in a hot oven.
Cut into small pieces and press out the juice, using a meat
press which has been heated. Season with salt and serve
either hot or cold.
Starch free soup
1 cup chicken broth A little finely chopped pars-
/4 cup milk ley
2 tbsp. cream or piece of
Salt to taste
Pour all these into a saucepan — bring to a boil, cool
to medium heat then add 1 egg well beaten. Cook
slightly over hot water, and serve.
3 lbs. chicken 3 pts. water
Allow 1 lb. — 1 pt. of broth
Thoroughly clean a chicken, remove skin and fat, wipe
with a damp cloth, separate joints and put in a kettle and
add cold water. Let stand 1 hour. Heat slowly and sim-
mer 3 hrs. or until meat is tender. Strain and season and
when cold remove fat.
1 cup milk 1 tsp. butter
6 oysters Salt
Heat milk. Cook and strain the oyster juice. Add
oysters and cook until the edges curl. Add seasoning, but-
ter and hot milk. Serve at once.
This soup may be thickened with one teaspoonful flour
cooked in the butter as for white sauce.
Scraped beef balls
2 tbsp. scraped beef Salt and pepper
Chopped parsley Onion juice
Scrape the meat from the connective tissue with a dull
knife or spoon. Season and make into little balls and
broil or pan broil. Garnish and serve hot.
Scraped beef may also be used raw in sandwiches.
1 egg Sugar to taste
1 cup milk Flavor to taste
Beat the egg, add sugar, then the milk and flavoring
1 egg 2 tbsp. lemon juice
1 tbsp. sugar 1 cup cold water or vichy
Beat the egg, add sugar and lemon juice — then the
water gradually stirring until blended.
Soft cooked egg
Place the egg in 1 pt. boiling water, remove from fire,
cover and allow it to stand from 3 to eight minutes in
saucepan where the water will keep hot but not boil-
3 minutes — very soft 6 minutes — medium
10 minutes — firm
PRACTICAL HOME NURSING
Break the egg into a saucer. Slip the egg into boiling
salted water at simmering point and cook until firm.
Serve on a slice of toast. Season.
1 egg 1 tsp. butter
1 tbsp. milk Salt and pepper
Beat yolk and white separately. Add seasoning and
milk. Heat an omelet pan, rub with butter. Turn in
omelet. When it is set and browned, fold over and serve
1 e ££ 4 tsp. sugar
1 cup milk Pinch of salt
Flavoring to taste
Beat eggs, add sugar and salt.
Add scalded milk slowly. Flavor and bake in custard
cup m a pan of hot water until set, about 20 minutes.
To test when done, dip a pointed knife into water,' then
plunge m middle of custard. If knife comes out clean the
custard is done; if milky it is not cooked enough. If
cooked too long, custard will curdle.
J uice % lemon 2 eggs
2 tbsp. sugar
Separate yolks and whites. Beat yolks with sugar until
well mixed, add lemon juice and place bowl in dish of hot
water over the fire Stir slowly until it begins to thicken,
then add beaten whites and stir until the whole forms a
thick cream Remove from fire, pour into dishes and set
aside to cool.
Rennet or junket
1 pint milk Vanilla to taste
y 2 tbsp. liquid rennet or 1 tbsp. of sugar
half a junket tablet
Heat the milk until lukewarm, add sugar and vanilla
and rennet. Pour into a dish, leave until firm, then put
in ice box. Sprinkle with nutmeg. Serve with cream.
3 tsp. gran, gelatine 1 pint boiling water
2 tbsp. cold water 3 tbsp. sugar
4 tbsp. lemon juice
Soak the gelatine in cold water, add the boiling water,
sugar and juice, stir until sugar is dissolved, strain and
3 tsp. gran, gelatine 3 tbsp. sugar
2 tbsp. cold water 1 cup orange juice
1 cup boiling water 1 tsp. lemon juice
Same method as for lemon jelly.
2 tsp. gelatine % strong coffee
4 tbsp. cold water 4 tbsp. sugar
1 cup cream
Soak the gelatine in cold water until soft, then add the
hot coffee and the sugar. When gelatine is dissolved and
begins to thicken, add the cream which has been previously
whipped, then pour into a glass dish.
Ventilation means the substitution of pure for impure
air in any enclosed space. The chief constituents of air
are nitrogen, oxygen and carbon dioxide. Of these,
oxygen is the element that supports life, but can only be
breathed in combination with the other natural elements
of the air. The amount of nitrogen is the same in the air
breathed in and in that breathed out, the chief difference
being in the excess of oxygen taken in with fresh air, and
in the excess of carbon dioxide exhaled from the lungs.
Inspired air :
Nitrogen 79 per cent.
Oxygen 20.96 per cent.
Carbon Dioxide 04 per cent.
Nitrogen 79 per cent.
Oxygen 16.03 per cent.
Carbon Dioxide 4.38 per cent.
Carbon Dioxide is the element produced by the com-
bination of oxygen with a substance or any element in a
substance with the consequent result of creating heat or
This heat is generated in animal life and gives the sup-
ply necessary to create energy. It also results from the
processes of fermentation and from decomposition of ani-
mal and vegetable matter. The greater part of this gas
breathed out from animal life is utilized by plant life
which in turn gives off oxvgen to animal life/
Impurities of inside air. The impurities of inside air
are largely the result of perspiration, respiration and of
combustion, which is constantly generating carbon diox-
ide; it also results from dust, dirt (including the lack of
cleanliness of utensils) and from delay in removing waste
or garbage of any kind, or from defective plumbing.
Excessive moisture in air. The exhaustion and head-
ache that so frequently result from being in badly venti-
lated and overcrowded places are considered to be largely
due to the combination of heat (the air exhaled being
warmer), and excessive moisture (as moisture passes
from the body with every breath). This prevents the
normal evaporation from the body and therefore the heat
and waste (that usually pass off from the body) are re-
The constant inhaling of impure air from badly venti-
lated rooms undermines the constitution and leaves one
liable to develop disease very readily when exposed to
germs. This is the most generally recognized cause of
disease. Fresh air is of the greatest importance as an aid
in the development of physical health, energy and mental
activity and in the restoration of health. The general
health is frequently greatly improved by securing the ad-
mittance of fresh air by day and night, or by living in the
outside air as much as possible.
Ventilation of room. Natural ventilation implies
movement of the air and therefore no indoor air can be
just the same as that of outdoors, and in ventilating a room
this movement of air is a most important factor to con-
sider. Have currents of air at different heights, as far as
can be arranged. It is the constant circulation of air and
the means of its supply and escape that form the essentials
of good ventilation.
In any space, the air breathed out by human beings or
animals is at the normal temperature of the body — about
98° — and this being warmer rises; while the colder air
46 PRACTICAL HOME NURSING
entering the room replaces it. Therefore in order to ven-
tilate a room, at least one place must be provided to ad-
mit fresh air and another (in the upper part of the room)
to allow for the escape of impure air. This is usually
accomplished by means of windows, doors, transoms, fire
places or an adjoining room. A fire place aids ventila-
tion by heating the air around it which consequently be-
comes lighter and rises up the chimney, leaving a vacuum
to be filled by cold, fresh air. A lamp burning in the
grate, makes a substitute for a fire. A steady dilution of
impure air by a constant supply of pure air is the most
consistent way of ventilating a patient's room, and this
must be arranged without draught in the sick room.
Temperature of room. The average temperature of a
patient's room should be from about 65° to 68° and a
thermometer should be placed in the room where it will
register the average heat, and not near the window, fire or
Methods of ventilation. (1) One method is to open
the window from the top only, to allow for the escape of
air in the upper part of the room, while another current
enters the room from between the sashes.
(2) Open the window from the top and bottom. This
provides three different currents of air and if necessary a
screen * can be placed in front of the window higher than
the lower open space to prevent draughts and to direct the
lower current slightly upward.
(3) If there are two windows in the room, the upper
sash of one can be opened and the lower sash of the other.
(4) Window board ventilation: This is a contrivance
to assist in ventilation and consists of various methods.
Method (1) In this case, have the window opened from
the top and a piece of board about 10 inches deep placed
under the lower sash. This allows air to come in between
the sashes constantly without a direct current.
Method (2) This consists of a frame-work of wood
covered with wire netting and placed permanently against
the inside of the sash at the top so as not to interfere with
the opening or shutting of the window and at the foot a
small box arrangement about 6 to 9 inches high, fitted
with a wire covering, placed in the same manner at the
lower part of the window, extending across the window
sill and not interfering with the opening and shutting of
the window. This is an excellent way to admit air with-
(5) When access to direct outside air is not feasible,
fresh air can be admitted from an adjoining room if this
is well aired first.
(6) In cold weather, it is a good plan to open all the
windows in a patient's room at the time of day when the
air is warmed by the sun, and have the patient covered
with extra blankets and protected by a screen.
In hot weather, this plan is reversed and the cooler part
of the day chosen for such purpose. An electric fan is a
valuable aid to keep the air circulating.
When gas or kerosene is used for lighting, or heating a
room, more fresh air is needed, because this combustion
uses up oxygen. For this reason, electric light is consid-
ered best for use in a sick-room.
Undue dryness in air. The air frequently becomes too
dry in artificially heated rooms and causes irritation to
the mucous membrane of mouth, throat, nose or eyes.
Moisture should then be provided by such means as : —
(1) Steam from a boiling kettle in the room (or in an ad-
(2) An open vessel of water kept on the radiator, or
wet cloths hung in the room.
Note. * A practical screen can be made by fastening a
piece of muslin or blanket to the casement of the window
high enough to prevent a direct current when the sash is
open. Inside shutters can also be utilized for the same
48 PRACTICAL HOME NURSING
What is the principle of ventilation ?
State difference between inspired and expired air.
What effect has excessive moisture in air on health ?
In what part of room would warmest air be found ? Why ?
Describe different methods of ventilating a room.
Mention practical methods of preventing draughts.
What advantage has electricity over other forms of light-
ing a room ?
How may disease be caused by impure air ?
Bacteria, germs, microbes, are all names used to de-
scribe the many different forms of minute living bodies of
plant life that are all around us in air, water, earth and
almost everywhere. They are the smallest known form
of vegetation and start in one cell which divides into two,
and in this way they multiply very quickly if conditions
are suitable for their development. Some germs later
develop spores or seeds which have great resistant power
and are more difficult to destroy than the germs themselves.
Beneficial bacteria. Bacteria is so freely talked of
in connection with disease that it is easy to forget that it
also has a beneficial function, and is essential to Nature's
plan for the constant interchange that is taking place be-
tween the animal and vegetable kingdoms, keeping a bal-
ance and preventing a waste from either, promoting the
growth of plants and destroying dead, organic substances.
And in fact, life itself is dependent upon these little living
BACTERIA IN DISEASE
These are called pathogenic or disease producing
germs and they develop in animal or plant life, causing
disease if conditions are favorable for their growth. They
are liable to enter wherever the natural defense is weakened
as in any susceptible part or when the general health is
below its normal condition. Frequently the lowering of
vitality may be attributed to overwork, lack of sufficiently
nourishing food or fresh air.
Preventive measures. It is most important to pre-
PRACTICAL HOME NURSING
vent in a practical way the conditions existing that are
favorable to germ development by such preventive meas-
ures as (1) plenty of sunlight and fresh air, (2) cleanli-
ness of surroundings, (3) a safe disposition of refuse of all
kinds (by burning if possible, or by the use of chemical
agents), (4) maintaining a healthy body by personal clean-
liness, exercise, elimination of waste from the body, suit-
able food and sufficient fluid taken into the system, and all
the various things that tend to keep up a normal health
Disease germs develop rapidly where (1) bad sanitary
conditions exist, (2) where there is dirt, as this is a sur-
face for bacteria to settle on, (3) where there is the com-
bination of heat and moisture, (4) where there is bad ven-
tilation, (5) where there is lack of good health, or lowered
vitality, poor circulation of the blood, unhealthy teeth, lack
of sufficient food or water, besides such germ carriers as
dirty hands and nails, house flies, insects, vermin, etc.
Infection. An infection is an invasion and growth in
the body of germs that cause disease, different kinds pro-
ducing different effects, on the substance upon which they
feed. Each disease has its own particular germ that re-
produces its own kind.
Indirect infection is transmitted by air, food and
Direct infection is transmitted by such mediums as the
mucous membrane of the body, the mouth (breath), cloth-
ing, skin, etc., and is spread particularly by the discharges
that come from that part of the body where the disease is
located, as for example :
The discharge from the lungs in tuberculosis,
From the intestines when the disease is there,
And from the mouth and nose and throat, or
Direct discharges from the infected area as in a wound
or a skin disease.
Infection may be spread also by being carried into other
tissues of the body by reabsorption.
BACTERIA IN WOUNDS
The unbroken skin of the body is a strong guard against
the entrance of bacteria into the system, but if the skin
is broken the danger of infection arises at once. For that
reason, the greatest care should be taken in the treatment
of even a small cut or wound. The injury itself may not
amount to much but the danger of infection does.
Various germs enter wounds and in various ways. In
case of accident, the germs are liable to be introduced by
any dirt getting in at that time, or by the instrument of
whatever kind that caused the wound, (2) if a wound is
not kept clean, infection may develop in the wound itself,
(3) if the cleansing fluid applied to wash out wounds, or
the dressing used, is not in itself perfectly free from
germs, infection can be absorbed in that manner.
Process of wound healing. Wounds heal by forming
new tissue which fills up the space solidly from the lowest
part of the wound up to the surface. A clean wound is
one in which no injurious bacteria exist. All prepara-
tions to have things sterile are meant to prevent the en-
trance of such germs and no detail in preparation can be
carelessly attended to without danger of bad results.
Treatment of wounds. To treat a cut or wound with-
out disinfectants, let the part bleed a little first to remove
any poison taken in at the time of the accident. Then
cleanse with water that has been boiled and cooled and
apply a sterile dressing as described on page 54. Apply
this dressing wet ; or a dry dressing taken from a previ-
ously unopened sterile gauze package may be used, being
always careful not to handle the dressing at the part which
will come in direct contact with the wound. Bandage this
on and place the injured part in the most comfortable posi-
tion for resting, as quiet to the part is essential. If anti-
52 PRACTICAL HOME NURSING
septics are obtainable, they may be used in place of the
sterile water mentioned above.
Sepsis means poison produced by putrefactive bacteria.
A septic wound is an infected wound.
Asepsis means freedom from infection.
Sterile means free from germs.
An aseptic wound or dressing is one free from germs,
An antiseptic is an agent by whose means the growth
of germs is prevented (but it does not kill them). In a
wound antiseptics prevent putrefaction by virtue of their
action in arresting the growth of organisms or the chemi-
cal activity of certain substances which give rise to fer-
mentation and decomposition. They include carbolic acid,
boracic acid, iodine, alcohol, balsam of Peru, and many
A disinfectant is an agent which kills germs. In a
wound disinfectants destroy germs or active chemical sub-
stances on the surface already infected or foul. They are
for the most part the same material as the antiseptics but
are used in a much stronger form, as strong solution of
carbolic acid, iodine, etc.
Deodorant is an agent used to destroy odor. The best
deodorant is fresh air. Chemical deodorants absorb gases
and neutralize foul odors. Those chiefly used are char-
coal, permanganate of potash, etc.
The important point in modern methods of treating a
wound is to have preparations made beforehand in order
that all things used in such treatment may be perfectly-
free from germs, or as it is called, sterile.
Sterilization is a method of destroying germs with heat
by such methods as :
Boiling temperature 212°
Steam pressure temperature 230°
Dry heat 300°
In hospitals and large sterilizing plants the heat is ar-
ranged in large sterilizers and the dressings, instruments,
or any articles to be rendered sterile, are left in the ster-
ilizer at a definite heat for the required length of time.
General disinfecting of utensils, instruments, dressings
for wounds (cotton, gauze), fluids or lubricants, and
clothes, is usually done by the process of sterilization, but
chemicals are also used for this purpose. The latter,
however, are used chiefly in strong solution for disin-
fecting the direct discharges that contain germs, or at a
weaker strength as antiseptics. But their use and
strength should be governed by the physician in charge.
Any sterile solutions of the strength required, dressings,
gauze, cotton, instruments or utensils, are obtainable in
sterile, sealed packages at a local drug store.
Practical suggestions for sterilization. In house-
holds where there are not likely to be any definite ar-
rangements for such a purpose, sterilization may be most
practically accomplished by first cleansing the article and
then boiling it for the required time and using it undried
when taken out of the water, unless there is a sterile sub-
stance to dry it on.
To make sterilization consistent and of any use, do not
touch the sterilized article with the fingers, if possible to
use a sterile instrument, such as forceps, or sterile scissors ;
and in any case, the part to come in direct contact with the
body must not be made unsterile by careless handling.
PRACTICAL HOME NURSING
To sterilize a dressing. To sterilize a dressing, place
the gauze, cotton, linen or old muslin, folded in a conveni-
ent size, in an outside cloth and pin or tie together, and
then boil for twenty minutes. Wring partially dry (while
still in the outside cloth), then apply the inside dressing
moist, taking care not to touch your own fingers to that
part of the dressing which is to be applied to the wound.
To sterilize towels. To sterilize towels, wrap several
together in an outside cloth and boil twenty minutes ; wring
out as described above and use the inside towels while they
To sterilize rubber. Gloves, bags, tubings, or any
rubber utensil, may be boiled from two to five minutes.
These may be wrapped in a cloth and removed from the
water without touching, or they may be boiled directly in
the water and removed with sterile forceps, without touch-
ing that part which will come in contact with the patient.
Never use soda when boiling rubber as it softens it too
To sterilize instruments. Needles, scissors, iorceps,
nail files, etc., are sterilized by placing them in boiling
water in which 1 per cent, of soda has been dissolved (this
is to prevent rusting), and boil for five minutes.
For glass utensils, tips, nozzles, etc., place them in cold
water, bring to a boil, and boil five minutes.
For larger utensils, place them in a large sauce pan or
washing boiler and boil for ten minutes (active boiling).
To sterilize gauze or cotton. To sterilize gauze or
cotton or the stoppers of babies' bottles, place them in a
bottle with an airtight cover, surrounding this with cold
water, (do not let the bottle come in direct contact with
the bottom of the pan), and bring the water to a boil.
Keep it boiling for an hour.
Fluids, oils, or tubes of vaseline can be treated in the
same way and thus made sterile. Water can be sterilized
by straining or filtering it and then boiling it, taking care
that it is kept in a sterile receptacle.
METHODS OF DISINFECTING
Disinfecting. Generally speaking, sterilization means
the process of destroying germs by heat, while disinfecting
usually implies the use of chemical agents. This latter
method is especially used to destroy germs in direct dis-
charges from the body. These chemicals are strong-
poisons and should only be used by the direct orders of
Stools, or movements from the intestines. Use the
particular disinfectant in the strength ordered by the
physician. Place as much of this as there is fecal matter
in the vessel, stirring it thoroughly with an implement
that can be boiled or destroyed (for instance a glass stick
which can be easily boiled). Over this vessel place a cloth
wrung out of the disinfectant and leave it from one to two
hours. Then the stools can be safely disposed of in the
usual way and the vessel rinsed and thoroughly washed
with soap and water.
Urine. Place equal parts of urine and disinfectant to-
gether, leave for half an hour, and then dispose of in the
Vomited matter may be treated in this same manner.
Sputum should be disinfected when it contains germs
from a diseased condition local to lungs, nose or throat. If
it is possible have the patient use paper sputum cups
and burn these intact. But if this is not practical, have
the patient expectorate into a cup in which there is a little
water (to prevent sputum drying and allowing the germs
to escape into the air). At intervals of at least every six
56 PRACTICAL HOME NURSING
hours, mix the sputum that has collected iu the cup with
the ordered disinfectant. Leave it for an hour, covered,
and then dispose of it in the usual way. If cloths are
necessary to catch the sputum, substitute if possible paper
napkins, or use old cloths which can be burned ; otherwise
these must be disinfected like any other receptacle, or
boiled at once, as they contain the direct discharge.
Clothes should be boiled as this destroys the germs.
They are usually kept in a weak solution of chemicals
until a convenient time to boil them. The weak solution
of chemicals only prevents the growth of the germs tem-
porarily, while boiling directly kills them. If there is
any discharges on the clothes they should be boiled at
Dishes. The simplest and surest way is to boil them
for ten minutes. If this is not feasible, they may be left
in the ordered solution of chemical disinfectant for half
an hour and then washed with soap and water as usual.
Those dishes coming in direct contact with the mouth, such
as cup, glass, spoon, fork, etc., should be boiled.
Hands. Scrub the nails, hand and forearm thor-
oughly with a brush, soap and water for five minutes, then
hold the hands in a chemical disinfectant as ordered for
another five minutes. If no disinfectant is to be used
after the washing, alcohol (from 50 per cent, to 70 per
cent.) may be thoroughly rubbed into the hands. Dry
the hands on a sterile towel, or shake them dry.
Chemical solutions. The chemical solutions most
commonly used for direct application to the body are:
Salt, or saline solution, made by adding 1% teaspoon-
fuls or 90 grains of salt in 1 quart of water and boiling.
This is chiefly used for washing out wounds, cavities, for
all sorts of irrigations and douches, and is not irritating
to the surface when applied in this strength; and
Boracic acid solution, made by adding 1 part of boric
acid powder to 24 parts of boiled water, which equals a
solution of 4 per cent. This is used in strength varying
from 2 per cent, to 5 per cent. It is particularly non-
irritating and is used for eyes, nasal sprays, irrigation for
wounds, cavities, etc.
These two solutions while largely used on the body sur-
face or in cavities are not strong enough to be effective as
Alcohol, 95 per cent., or weaker (50 per cent.-70 per
cent.) may be used for external disinfecting of the skin or
for disinfecting instruments or thermometers.
Milk of lime solution (1 part of slaked lime to 4 parts
of water) is used for disinfecting discharges. Other
chemicals sometimes ordered by a physician are :
Carbolic acid solution (2 per cent.-5 per cent, strength)
— 6 drams or teaspoonfuls to 1 pint of water makes a 5 per
Bichloride of mercury — /iooo to %ooo strength — 7/4
grains of bichloride of mercury to 1 pint of water makes
the strength of Mooo-
Formalin solution — 4 per cent.-lO per cent, strength.
This comes in a 40 per cent, solution, 1 part of formalin
to 9 parts of water makes the strength of 4 per cent.
DISINFECTING A ROOM
In case it is necessary to disinfect a room after an ill-
ness of an infectious nature, it is fumigated and the in-
fection destroyed by the gases of the chemicals used. This
process is also used for cleansing rooms from insects, ver-
Preparation of room. Gather such things as books,
toys, etc., that have been used by the patient, and if there
is a stove or grate in the room burn them. Otherwise,
have them taken 1o a furnace and destroyed after they
have been fumigated with the rest of the room.
58 PRACTICAL HOME NURSING
Open bureau drawers and closets and hang up pillows
and blankets on a line and spread the mattress so that the
air gets underneath it. Close windows and ventilators
and cover fireplace. Close up all crevices around doors,
etc., by strips of paper pasted over the openings (use simple
flour paste which can be easily wiped off).
Method. Have water in a large dish pan or tray near
the floor with a protector under it. Formalin candles
are generally used for this purpose, placing three or four
(for an average sized room) in this dish of water, sup-
ported on the tin stands that come with them. As there
is no wick in them, hold a taper or candle to the edge until
the ash begins to get white and fall away. This liberates
the gas into the room and disinfects it. Moisture •in room
makes it more effective.
If sulphur is used, make the same arrangements, and
place 4 or 5 lbs. of rock sulphur (for an average sized
room) in a sauce pan, saturate with alcohol, and when
this pan is placed in a larger one light the alcohol to start
the sulphur burning. The door should be closed and se-
curely sealed from the outside. Leave the room for twelve
to twenty-four hours, then open the windows and thor-
oughly air and clean the room. Sulphur fumigating is
frequently used for destroying vermin. Sulphur will de-
stroy roaches but not ants.
When entering a room after it has been fumigated, to
open the windows, hold a damp cloth to the mouth and
nose to prevent the irritating effect of the gas on these
What is meant by sterilization '(
How does a wound become infected ?
How prevent such infection ?
Describe methods of disinfecting sputum.
Mention some of the mediums through which infection is
How would you sterilize rubber gloves ?
How make a saturated solution of boracic acid ?
How make normal saline solution ?
In an emergency how would you cleanse and dress a cut
THE MODEL SICK ROOM
Beds — Changing Bedding
TJl er normal circumstances, the average person takes
little notice of minor details in the location and furnish-
ing of a room. However, in time of illness the mind is
more sensitive to uncomfortable or inharmonious sur-
roundings and therefore the immediate environment de-
serves the closest attention.
The conditions described here are practically ideal and
will be difficult, perhaps, to duplicate completely outside
of a private hospital or sanitarium. They should, how-
ever, be approximated, especially when the illness itself
promises to be long or to be followed by a tedious conva-
lescence. Some of the favorable points will be found in
almost any room. Look for these and make the most of
them, trying as far as you can to minimize or correct the
Room. The room itself should be situated near the top
of the house for isolation, quiet and better air, and should
open into an adjoining room and be near a bath room.
It is desirable to have a southern or western exposure and
to have the room large and airy, with two windows (pro-
tected by light and dark shades) and an open fire place.
Floors. Hard or plain wooden floors are preferred
covered with small, washable rugs.
Walls. Neutral tinted or plain paper should be used,
avoiding stripes or figures which become most irritating
to the average invalid who finds opportunity for tracing
monotonous designs in every line.
THE MODEL SICK ROOM
Furniture. A white enameled or brass bed (for size,
etc., see page 63) should be placed with an open space
around it, also a duplicate bed should be provided if
possible; a bedside table, two small tables, a screen, a
sofa, large comfortable chairs and two or three straight
chairs, a hassock or foot stool, an electric reading lamp
with shade. Growing plants and cut flowers add mate-
rially to the " atmosphere " of a room and dainty cur-
tains of washable material also help to make the room
look attractive. A thermometer should be hung near the
center of the room and some means of attachment for a
syringe bag should be provided, such as a hook in the wall
near the bed, or an improvised stand like a coat rack, or
high backed chair.
Adjoining room. The neighboring room should be
supplied with an ice box (and ice pick), some apparatus
for heating water, food, etc., such as a gas or electric stove
or an alcohol lamp, in which denatured alcohol should be
used. Guard against fire by placing whatever stove is
used on a tray over an asbestos mat.
Utensils. There should be at hand a large, enameled
or granite bed pan, a small bed pan (to use as urinal), a
douche pan, a fountain syringe bag with attachments, hot
water bags, an ice cap, bath thermometer, clinical ther-
mometer, two hand basins, small basins, pitchers, drinking
glasses, small trays, glass drinking tube, spoons, 2 medi-
cine glasses, a measuring glass, a bed tray or table and foot-
stool. A supply of paper bags, two rubber sheets or oil-
cloth or newspaper as substitute, soap dish with castile
soap, two blankets for bathing purposes, an extra blanket
or rug, pillows, back rest or substitute, a foot tub, a
hamper, cotton, gauze, alcohol — both denatured and 95
per cent. ; a good supply of linen should include bath
towels, face towels, face cloths, sheets (large and smaller
for draw sheets), pillow cases, tray cloths, napkins and
PRACTICAL HOME NURSING
some pieces of old linen which may be torn up as needed,
also personal linen.
Where there is not constant attendance, some method of
signaling attention should be arranged for the patient,
such as a bell or an electric buzzer.
When there is a grate in use, avoid making dust while
removing the ashes. When necessary, coal can be wrapped
outside in paper and gently laid in the grate to avoid noise
The bath room should be clean, tidy, and well ventilated.
Care of cut flowers. Once in twenty-four hours,
water should be changed on all flowers and the stems cut
off about an inch. Flush water over the stems and re-
place in freshly filled vases. It is wiser to remove cut
flowers from the patient's room at night and return them,
freshened, in the morning.
CARE OF THE SICK ROOM
Whoever is in attendance will be held responsible for
the condition of the sick room and for its being clean, tidy,
well ventilated and attractive.
Sweeping. In cleaning a room, care should be taken
not to raise unnecessary dust for the patient to breathe.
Any small rugs should be removed from the room and
brushed outside. Wood floors should be wiped over with
a dustless mop or with a broom covered with a slightly
damp soft cloth. Where there are carpets, a vacuum
cleaner can be used to great advantage, as it minimizes the
discomfort of flying dust. Also if, there are carpets or
rugs which cannot be moved out of the room, a carpet
sweeper — with its brush slightly dampened, may be used.
Dusting. Use soft, clean cloths for dusting, gathering
the dust within the cloth and not allowing it to be scat-
tered about. Never use damp cloths on polished furni-
ture. Protect the furniture from scratches and spots.
THE MODEL SICK ROOM
Especially when using alcohol, care should bo taken not to
splash or spill it as this leaves a mark on furniture.
Glasses containing fluids should be kept on a plate or
small tray, and when using basins, place a protector under
them, such as paper or rubber cloth.
Place any dressings used, or cloths on which there is a
discharge from any part of the body in a paper bag, and
remove and burn as soon as possible.
All bottles should be clean and carefully labeled and
any medicines kept in a safe place.
The dishes and table silver used should be kept clean
and well polished.
All necessary appliances such as syringes, bed pans, etc.,
should be kept out of sight until needed.
Of chief importance to the patient's comfort is the bed
to be used and the way it is made.
Kind. A white enameled iron or brass bed, strong
enough to stand firmly on the floor, is the simplest kind
to keep clean and the easiest to move about when necessary.
This should be fitted with a double woven wire spring or
the newer type of spiral spring.
Size. The usual dimensions are 6 feet, 6 inches long
by 36 inches wide and 26 inches high. A three-quarter
or 45-inch bed is as wide as can be conveniently managed.
In many circumstances a double bed is the only available
one and when a double bed is used, the patient may be
moved from one side to the other night and morning, thus
providing a change and a certain amount of rest.
Height. Twenty-six inches is a good average height
and practically any bed can be adjusted to this height by
raising the legs of the bed on wooden blocks. If these
blocks are grooved or made concave, the castors will drop
PRACTICAL HOME NURSING
into them and there stay securely. A good sized, firm
stool or hassock is most convenient to have at hand, par-
ticularly when the bed to be used is high.
In cases of long illness it is imperative to have a bed
which is, first, comfortable for the patient, and second,
convenient for the attendant.
Mattresses. A light-weight, hair mattress is prefera-
ble to any other kind, being firm, elastic and comparatively
easy to turn ; cheaper grades of felt or cotton may be used
but are much heavier. An air mattress is used only under
special conditions to help equalize the pressure on the body
and to prevent bed sores. It must be partly filled with
air and placed on top of the other mattress and should be
at least 45 inches wide to be comfortable. It is expensive
and made of rubber which punctures easily, and so re-
quires careful use. A blanket should be spread between
the air mattress and the lower sheet.
When a hair or cotton mattress has been used for some
time, there is a tendency for it to sag in the middle. This
fault can be remedied by pinning, with large safety pins,
or by sewing, a folded blanket or pad to the under side of
the mattress under the depression. This will raise it to
the proper level and prevent the strain that would other-
wise be felt on the patient's back.
Pillows. The usual, medium sized pillows are made of
feathers covered with striped ticking. A hair pillow is
sometimes used as a foundation pillow, while small hair
pillows (not too full, and covered with fine ticking) are
cool and comfortable to place around the body. These will
be found preferable to the usual small, down pillows. Air
pillows are of value for many purposes, particularly when
a patient is riding or being moved in a chair, or when
there is occasion to sit still for any length of time.
Pillow cases. Pillow cases should preferably be of
linen or fine cotton material.
THE MODEL SICK ROOM
Sheets. Sheets are usually made of cotton as linen
has a tendency to chill the surface of the body. Flannel
sheets are used in special cases. The size of sheets is
important. They should be one yard wider and longer
than the mattress on which they are spread to allow for
sufficient surplus to tuck in firmly.
Draw sheets. Draw sheets should be provided to fit
over the center of the bed and tuck in well on each side.
They should be from a yard to a yard and a half wider
than the mattress. Any narrow sheet, used lengthwise
across the center of the bed, provides a good draw sheet.
Blankets. Blankets should be light in weight and
color. It is better to use two or three light weight blan-
kets than one heavy one ; as not only are they more easily
handled and more comfortable to the patient but warmth
may be much more readily adjusted where there are vari-
ous layers to apply and remove. All-wool blankets are
lighter and warmer than cotton, although in summer a
cotton and wool mixture may be more comfortable.
Spreads. Spreads should be of light weight material
— a sheet makes a good substitute.
Rubber sheets. These are made of double faced rub-
ber sheeting, white, black or colored, and are placed to
protect the mattress, usually between the lower and the
draw sheet. Oilcloth or newspapers can be used as sub-
A closed bed. In making a bed see that it has been
freshly aired and that the mattress is turned. A light
pad or blanket should be provided to protect the mattress.
Over this should be spread the under sheet, the wide hem
to the top and a greater surplus left to tuck in at the head
than at the foot of the bed. Tuck the sheet in first at the
head of the bed, then at the foot of the bed and then down
one side ; going to the other side of the bed, pull the sheet
66 PRACTICAL HOME NURSING
snugly across, tucking it in firmly and seeing that the cor-
ners are neatly squared.
All sheets and blankets must be placed with the center
fold to the center of the bed so that they will not wrinkle
when stretched to be made tight.
If it is necessary to protect the mattress, a rubber sheet
may be placed over the under sheet and tucked in at both
sides before the draw-sheet is spread.
The draw-sheet is tucked in firmly on one side, then
stretched and tucked in on the other. If a double sheet is
used for this purpose, the fold must be towards the top of
The upper sheet should be placed with the wide hem at
the top, right side down so that when the sheet is turned
back over the bedding, the smooth side of the hem will be
uppermost. The edge should just reach the top of the
mattress, leaving the remainder to be tucked in at the
foot. The lower corners should then be squared and
Each blanket is put on like the top sheet, but not nearer
than 12 to 14 inches to the head of the bed. When the
blankets are adjusted, the top sheet is turned back over
them and tucked in down the sides loosely. Over all is
laid a light spread stretched evenly to the top of the mat-
tress and tucked in firmly at the foot, with the corners
mitered or squared and the sides left hanging.
Pillows should be shaken well down into their corners,
then flattened out and placed in position ; one across the
bed and the other standing up on it, folding any surplus
pillow slip well out of the way.
An opened bed — ready for use. To prepare a bed
for a patient: (1) slip one hand under the mattress and
raise it slightly while pulling the upper bedclothes out
with the other. Loosen the bedding in this manner from
both sides of the bed. (2) Fold the spread under the top
of the blanket and then fold the upper sheet down over
THE MODEL SICK ROOM
this. (3) Then, facing the foot of the bed, fold the
clothes back in parallel plaits across the bed to its foot
where they remain until needed to be drawn up over the
patient. The pillows are arranged one on top of another.
TO CHANGE BEDDING WITH PATIENT IN
To replace the upper sheet only. Spread the clean
sheet across the bed after removing all but one blanket
and the soiled top sheet. These may be drawn away
under the new covering and the outer bedding replaced and
tucked snugly in at the foot and sides with the corners
Sheets are more often changed than blankets in making
a bed fresh so that ordinarily the spread and top blanket
may be completely removed while the change is being
To remove top bedding. When necessary for any
purpose to do this, place a folded light blanket over pa-
tient's chest, loosen the bedding at the foot and fold it
back as far as the patient's knees; the bedding at the top
is then turned down over this in one deep fold, drawing
the blanket with it, then the sides one after another are
folded over making a square. This can be readily re-
moved and replaced, unfolding the square in the same
To change the under sheet. Remove the upper bed-
clothes as described. Then, steadying the mattress with
one hand so that the patient is not disturbed, loosen the
under sheet and the draw-sheet. Draw or turn the patient
to one side of the bed and fold back the soiled lower sheet
close to the body. Then spread the clean sheet smoothly
over the side of the mattress which is clear, leaving the
greater length at the top and taking care that the center
fold of the sheet is in the center of the bed. Tuck in
68 PRACTICAL HOME NURSING
tightly at the head and the foot, then along the side. Put
the draw-sheet in place and tuck in on the side bringing
the rest of it with the surplus of the lower sheet close to
the patient's body; then go to the other side of bed and
turn the patient away from you on to the clean sheet.
Remove the soiled ones and spread the remainder of the
clean sheets over the mattress, tucking them in securely
under the remaining sides and ends.
If a patient cannot well be turned, the knees may be
flexed and the lower bedding drawn under the body at the
hips, after which the shoulders and legs may be alternately
raised while the bedding is made smooth underneath.
To change a draw sheet. Fold the upper bedding
back a little, loosen the soiled draw-sheet, folding it closely
to the patient's side. Replace this with a fresh draw-
sheet, tucking it in on the side nearest you and spreading
the rest smoothly. Turn the patient back on this fresh
sheet and remove the soiled one, drawing the remaining
half of the clean sheet across the bed and tucking it in
The chief advantage of a draw sheet, aside from the
protection it affords the bed, is the ease with which it can
To change a draw sheet when a rubber sheet is
used, fold, spread over the bed and tuck in both together.
To change bedding when only one rubber sheet is
available. Loosen bedding on one side, fold draw sheet
close to patient's side, lay rubber sheet back up over the
patient's body, then fold lower sheet close to patient's side
and spread the clean under sheet. Bring down the rubber,
lay in clean draw sheet and tuck it in, turn patient over,
remove soiled draw sheet, lay rubber back over patient's
body, remove soiled under sheet. Draw over and tuck in
the clean one. Bring down rubber and spread the clean
draw sheet and tuck them in together.
THE MODEL SICK ROOM
In folding sheets in lengthwise plaits, as frequently
directed, divide it into an uneven number of folds with
the free edge topmost and nearest the side to which it is to
be drawn. This makes quicker and smoother arranging
To change the mattress with a patient in bed. The
mattress may be changed with a patient in bed by remov-
ing the upper bed clothes, leaving just a light weight
cover over the patient. Have two or three chairs on the
far side of the bed on to which the mattress can be slipped.
Draw the patient to the side farthest from the chairs and
slip the mattress half off on to them with the patient still
lying on it. Place three pillows on the springs for a
temporary mattress and draw the patient back on them.
Go to the far side of the bed, remove the sheet and turn
the mattress over (from the head to the foot), then re-
place it half over the wire springs. Spread a fresh under-
sheet and draw-sheet over the mattress and tuck in on one
side. Lift the patient back on to it, remove the pillows,
and draw the mattress into position. Tuck in the re-
mainder of the lower sheets and replace the upper bed-
ding and pillows.
To change the patient to another bed. Have a
freshly made bed of corresponding height conveniently
placed with the upper bedding folded back to the foot.
Draw the patient to one side of the bed, loosen the draw-
sheet and fold this over the patient while removing the
upper bedding. Bring the two beds together and, going
to the free side of the fresh bed, take the upper ends of the
draw-sheet and the pillow (on which the head and shoul-
ders rest) in one hand, and the lower end of the draw-
sheet in the other, and draw the patient carefully over to
the other bed. Draw up the upper bedding, remove the
draw-sheet and change the pillow.
PRACTICAL HOME NURSING
Note: This is more easily accomplished with an as-
To relieve the weight of bed clothes. If there is a
foot rail or board to the bed, the weight of the bed clothes
may be taken from the body by being drawn over the foot
of the bed and fastened securely either under the mat-
tress or around the foot rail. The corners and sides
should be folded diagonally and pinned to exclude any
draught. If the bed lacks a foot board a high back chair
may be used as a substitute, or a cradle which comes for
the purpose and extends across the patient's legs beneath
the bedding. Various substitutes may be improvised to
keep the weight of the clothing off the body, such as a box
with two sides knocked out.
To prevent slipping down in bed. 1. One method
of preventing slipping down consists in a board like a
swing seat which may be placed upright against the feet.
The tapes or cords at its sides are drawn tight and fastened
to the head of the bed low down. The board should be
deep enough to support the bedding and wide enough not
to interfere with the moving of the patient's feet, and
should have a small, hair pillow placed against it as a foot
2. A sheet folded diagonally into 12-inch plaits may be
used similarly, bringing it below the body so that the feet
rest in its center on a small pillow, and fastening the ends
securely to the sides of the bed.
8. Another method is simply to put a large pillow be-
neath the patient's knees, or for this purpose a pillow can
be fastened in a roll with tapes running through the center
of the roll and these tied to the sides of the bed, thus keep-
ing the pillow in position under the knee.
Changing a nightdress. Gown opening in front.
Flex the knees and draw the nightgown up and over the
knees, and from beneath the hips, well toward the shoul-
THE MODEL SICK ROOM 71
der. Draw the gown out and up to the point of the
shoulders. Slip the arm out of one sleeve, supporting the
arm comfortably, then lay the gown over the head, put
on the sleeve of the clean gown over the same arm, laying
this gown also over the head. Lift the head slightly, sup-
porting the neck, and draw both gowns from under the
shoulders. Take hold of the soiled one by the cuff and re-
move it. Put on the sleeve of the fresh one and draw the
gown well down from under the shoulders ; flex the knees
and bring it down beneath the hips and legs smoothly.
Slip over head gown. When the gown to be removed
is a closed one, proceed in the same manner as above.
A gown opened in the back is very convenient and
can be changed with little effort to the patient and this is
the hospital model. Remove one sleeve and replace with
sleeve of fresh gown and draw this gown across the body
over the soiled one (this keeps the patient covered). Then
slip off the soiled one and put on the sleeve of the fresh
one and pull down the gown.
Arrangement of pillows. Pillows, if well arranged,
mean comfort to the patient, and the particular parts
needing support in general are: — (1) head and neck,
(2) shoulders, (3) arms and elbows, (4) small of the
It is easier to arrange pillows both for sitting up and
when the patient can only be partly raised with the sup-
port of a bed-rest or substitute — a tray or board or a
stiff hair pillow.
In changing a pillow (one under the head) have the
fresh one ready on the far side of the bed. Lift the pa-
tient's head and shoulders with one arm by reaching over
the body and remove with the other hand the used pillow,
substituting the fresh one at the same time. Have the
pillow come well under the shoulders.
When two pillows are used, if the patient is lying on
72 PRACTICAL HOME NURSING
the back, have the first and lower one well beneath the
shoulder blades, with the second and upper one higher on
the bed to support the neck and head, but still under the
When several pillows can be used, place the largest one
nearest the patient's back and arrange the others in over-
lapping layers closer to the head of the bed. Slip small
pillows under the elbows and neck and in the hollow of the
Cage pillow. A cage pillow may be built to resemble
an arm-chair. Some firm support such as a stiff pillow or
a backrest should be laid against the head of the bed
(place a towel to protect from marking bed). Shake the
pillows well and place the two largest into an inverted V
behind the patient's body, with the lower ends where they
may support the elbows. Build two other pillows up on
these in same way, bringing them closer to the body so that
when the cage is complete the patient's back and arms will
be completely supported. A small pillow may be added
for the support of the neck and the head.
Patient sitting up in bed to read. Put on a wrap
and make a comfortable arrangement of pillows (cage or
overlapping pillows) with a small one to support the neck.
Place a bed-table or some substitute across the knees (not
on them) at the most convenient height to hold the book,
and have the light come from the back and be thrown on
Arrangement for sleeping when sitting up. In
cases when a patient cannot comfortably lie down, a bed-
table or a bed-tray covered with pillows may be laid across
the knees and the patient bends forward and lays the head
on it. The back should then be carefully covered and the
arms supported with small pillows.
For a patient who is lying on the back and can only be
partially raised, a crow's nest is arranged with one large
THE MODEL SICK ROOM 73
pillow and three small ones, as follows : — Two small ones
are crossed like an inverted V, with ends under the shoul-
ders on top of large pillow with third pillow where they
intersect, for the head.
When only one pillow is available, blankets or towels
rolled, may be substituted more or less comfortably.
Describe a model sick room and furnishings.
What sort of a bed would you select %
Describe suitable bedding.
Describe the process of making a complete bed for patient.
How would you change the under bedding — patient in
How could a patient be moved from one bed to another
How relieve the weight of the bed clothes over the feet \
What methods can be used to prevent slipping down in
Mention the parts of the body that need particular support
How arrange a patient comfortably to sit up in bed and
MOVING AND LIFTING A PATIENT
Purposes. To relieve pressure and thus keep circula-
To rest the muscles by changing the position.
To place the patient in a convenient position.
Suggestions for simplifying moving. Move the pa-
tient with a firm steady motion, using the level of the
entire hand and not merely the fingers.
Have the weight evenly distributed and move the hands
In order to make an easier move, draw the patient to-
wards you, rather than push her from you.
In moving, supporting or turning a patient, place the
hands under the bony parts of the frame, i.e., the shoul-
ders and the hips; otherwise the patient is made uncom-
fortable and a less firm purchase is to be had on the body.
When raising the center of the body for any reason,
have the patient flex the knees (or do this for her). In
this position the patient has much more power to raise her
body to assist you, or if too weak to do this, the hips are
still raised to some extent (by this position of the legs).
Always support the patient's neck in the hollow of your
arm, when moving the shoulders and head.
When a second person assists, the weight should be
evenly distributed between the two, and the movements of
both should be simultaneous.
MOVING AND LIFTING A PATIENT 75
To move a patient up in bed. Patients are very apt
to slip down in bed too far, and need assistance in being
drawn back on the pillows.
Method. Flex the patient's knees. Slip one arm
under the neck, and support the far shoulder blade with
the hand, the lingers reaching the hollow under the arm,
and the neck resting on the curve of your arm. Place
your other hand well under the hips, and draw the patient
up in bed by moving both arms together. If possible
while doing this, have the patient press on her heels to
To move a patient down in bed place the hands in the
same position, flex the knees and simply move the body
toward the foot of the bed.
To draw patient from one side of the bed to the
other. Place one arm under the shoulders as previously
described, with the other arm well across, and under the
hips. Draw the patient steadily toward you, moving both
arms at the same time. If the patient is too heavy to
move all at once in this way, use both hands in moving
each part, first the shoulders, then the hips, then the legs.
If assistance can be obtained, distribute the patient's
weight (after her knees have been flexed, as usual) upon
the four hands, placed well under the trunk, and move
To turn a patient on side. Slip your hands under the
patient's shoulders and hips and turn her on the side, at
the same time drawing the hips and shoulder back slightly.
Thus the weight falls directly on the side, relieving all
strain on the back. It is sometimes comfortable to flex
the upper knee and place a pillow beneath it for support.
To help a patient to a sitting position in bed. Place
76 PRACTICAL HOME NURSING
your arm under the neck and shoulder. Your other arm
is inserted under the patient's back from the other side,
reaching over the body to do so. Draw up the patient to
a sitting position.
To draw a patient who is sitting up in bed further
back towards the pillows. First flex the patient's knees.
Then, standing behind her, place both your hands beneath
the buttocks and draw the hands back together.
To lift a patient from bed. If two persons are to lift
a patient out of bed, they should both stand on the same
side. One of them places her hands under the neck and
shoulders (supporting the head) and the other hand in the
middle- of the back while the other helper's hands are
placed under the hips and just below the knees. Draw
the patient to the edge of the bed, then lift, taking care to
make all movements at the same time.
With a heavy person a third helper is necessary. The
weight should be distributed by four hands under the
trunk, and two under the legs.
To carry a patient in a sitting position. Draw the
patient to a sitting position in bed, and turn her around
with her back close to the edge of the bed. Have the at-
tendants form a chair with their hands and slip them
under the body, having the patient sit on the seat thus
provided, and support herself by placing her arms across
their backs with her hands touching the far shoulders. An
assistant is necessary and the " chair " is made by having
each person grasp her own left wrist with her right hand,
then each takes the other's right wrist.
To get a patient up in a chair. Articles required :
Chair Blanket or rug Wrapper Stockings
Pillows Foot stool Personal Slippers
MOVING AND LIFTING A PATIENT 77
Method. Place the chair close to the bed and arrange
one end of the blanket on it so that it can be used to cover
the legs and feet. Turn the bedding slightly back from
the side of the bed and draw on the stockings. Put on
the far arm of the dressing gown first, and draw it down
over the body, while removing the bed clothes beneath it.
Then with one arm beneath the patient's shoulders and
the other under the knees, draw your arms together, and
turn her to the edge of the bed, thus swinging the patient
to a sitting position. This is known as " pivoting " and
is usually quite easily done. With the patient sitting on
the edge of the bed, put on the other sleeve of the gown
and the slippers. Then, standing in front of the patient,
pull the gown down, put your hands under her arms and
with the patient's hands on your shoulders assist her to
the chair ; then wrap the blanket well around her legs and
arrange the pillows comfortably and if the chair can be
moved (on casters) take it to another part of the room or
to an adjoining room, thus providing a change of scene,
which rests the mind. Place a footstool under the feet
or provide some sort of support as a substitute. It is ad-
visable to take the pulse at intervals after the exertion of
getting up. If there are symptoms of faintness at first,
a drink of cold water and fanning will usually give relief.
If actually faint, the head may be brought forward and
down. Care should be taken not to overtire a patient
especially when first sitting up.
While the patient is out of bed turn the mattress and
remake the bed, leaving it with the upper bedding folded
back to the foot.
To help a patient back to bed. Draw the chair close
to the bed, then, standing directly before the patient, place
your hands under her arms and with her hands on your
shoulder assist her to a sitting position on the edge of the
bed, first lifting the skirt of the gown. Remove the
sleeve from the far arm and draw the gown away from the
78 PRACTICAL HOME NURSING
back. Place your arms under the shoulders and knees, as
described before, and bring them together, and pivot the
patient back into bed. Remember to have her placed,
when on the edge of the bed, near enough to the pillows so
that when pivoted around the head and shoulders will rest
on them without extra moving. Remove the dressing
gown, slippers and stockings, replace bedding and let the
To move an extremity. It is frequently necessary
to move a painful or sore leg or arm for various reasons,
or to elevate it (elevating a part eases the pain where there
For an arm. Support the elbow with one hand under
it and place the other under the wrist and move both
For a leg. Place one hand under the knee and with
the other support the ankle and move the leg steadily and
State points to consider for patient's comfort when mov-
State points to consider for your own ease when moving
How would you assist a patient to get out of bed ?
How arrange comfortably on chair sitting up ?
Describe method of moving an injured arm — leg.
How would you move a heavy patient from one side of
bed to the other ?
Describe method of turning a patient to lie on her side.
The matter of personal cleanliness is at all times impor-
tant in order to maintain general good health and comfort
and in time of illness this needs especial attention, not
alone to keep the skin in good condition but also to alleviate
various internal irregularities.
The skin. The skin is furnished with many small
glands, ducts and pores, and in some places these are more
numerous, as under the arms, at the soles of the feet,
etc. The sebaceous glands supply an oily substance which
keeps the skin soft.
Perspiration. The sweat glands separate the per-
spiration from the blood and this is passed out through
the pores or ducts. The average amount is about two
pints daily but this varies, influenced by such conditions
as outside temperature, exercise, etc. This perspiration
represents a form of waste that is being constantly elimi-
nated from the system and as all waste matter decomposes
rapidly, once outside the body, unless this is removed, the
odor becomes offensive and in time of illness this is even
more apparent. Perspiration also helps to regulate the
temperature of the body. The constant evaporation of
this fluid prevents the heat from accumulating, as for in-
stance — a person while exercising accumulates heat, the
skin at the same time throws off more perspiration — and
the temperature of the body is kept even.
Bathing. Baths are given for various effects and at
different temperatures, but the fundamental reason is to
stimulate the action of the skin, so that it can perform its
PRACTICAL HOME NURSING
various functions. By bathing — the blood circula-
tion of the skin is stimulated — the temperature of the
body is kept even — and the residue of the oily substance,
with the waste matter which is brought to the surface by
perspiration is removed. In most conditions a bath is
refreshing to the patient and soothing to the nerves.
Temperatures of baths.
Hot bath 105-110°
•Warm bath 90-100°
Tepid bath 80- 90°
Cool bath 70- 80°
Cold bath 60- 70°
Cool or cold baths are given for their tonic effect and
also to reduce temperature. A patient should be rubbed
constantly during such a bath to bring more blood to the
surface to have it cooled.
Hot baths are sometimes ordered for special reasons
to cause excessive action of the skin, to relax muscles or to
stimulate the heat of the body. Hot baths taken continu-
ally are enervating.
A warm bath with a non-irritating soap is the usual
bath for cleansing purposes. This sometimes may be
followed by a cold sponge to act as a tonic for the skin.
Soda, bran and starch baths are used to allay irritation
of the skin and are given warm or tepid.
A soda bath is prepared in the proportion of 8 ounces
of bicarbonate of soda (ordinary baking soda) to every
gallon of water. In this case the patient should be care-
fully dried without rubbing to avoid irritating the skin.
A bran bath is prepared an hour beforehand by plac-
ing two pounds of bran in a bag (cheesecloth or some
other thin material) and allowing it to soak in a tub half
full of water, and squeezing the bag often. Hot water
may be added immediately before the bath.
A starch bath is prepared thus : — mix about 8 ounces
of starch in a little cold water. Add sufficient boiling
water to make a very thin paste and mix this with the bath
Salt baths are given for their tonic effect on the skin.
Allow 2 or 3 pounds of salt to a tub half full of water, dis-
solved in hot water and then cooled to the desired tempera-
ture, which is usually cool or cold, although sometimes or-
dered quite warm.
Odor to perspiration. If the odor of perspiration is
very strong, even if care to bathe has been taken, this can
be lessened by using bicarbonate of soda or ammonia, 1
teaspoonful to a quart of water, and washing the parts
where the glands are thickest in order to counteract the
acidity in the perspiration which, in such cases, largely
causes the odor.
Dry skin. If the skin is unduly dry, rub in some lubri-
cant such as cocoa butter, oil, or cold cream after the usual
Moist skin. If the skin is unusually moist, alcohol
(95 per cent.) should be rubbed on after the bathing, and
the skin powdered with talcum.
Excessive moisture or " night sweat." Sometimes
due to sudden fall of temperature or extreme weakness
the skin perspires too freely, and excessive perspiration or
" night sweat " is the result. Care must be taken to pre-
vent a patient taking cold as the vitality is lowered under
Method of treatment. Pin a blanket around pa-
tient's neck and keep this over the body while removing
the wet clothes. Then rub the skin dry with hot towels
and apply warm alcohol (warmed by placing the bottle of
alcohol in hot water). Put on warm, dry clothing and
82 PRACTICAL HOME NURSING
GENERAL RULES FOR BATHING
The ideal times for bathing are in the morning or at
Baths should not be given sooner than 1% to 2 hours
after eating as, by thus increasing the circulation of the
skin, blood is brought from the stomach where it is needed
during the process of digesting the food.
The room in which a bath is taken should be warmer
than usual and without draughts.
Everything needed should be ready before beginning the
To increase temperature
To decrease temperature
To relax the muscles
To soothe the nerves
Chair Soap Wash cloths
Bath mat 1 face towel Personal linen
2 towels, warmed
Method. The room should be warm and without
draughts. Place a chair conveniently near with a towel
spread on it and a mat on the floor beside the tub. Fill
the tub half full of water at a temperature of 90° or, if
desired, the bath can be made warmer. Help the patient
both in getting in and out of the tub. Use plenty of
castile soap and a rough wash cloth. Rinse the skin well
and when drying, rub briskly with a warmed towel to in-
crease the circulation. Have the patient rest for at least
an hour afterwards.
Note. When a patient is taking her own bath, always
stay within call in case your assistance is needed.
SPONGE BATH IN BED
To keep the pores of the skin open.
To give comfort to patient.
To remove waste material given off through the skin.
2 basins Small blankets
1 face towel Soap
2 bath towels Alcohol
2 wash cloths Powder
Personal and bed linen
Method. Half fill one basin with water at a tempera-
ture of 110° and the other with cooler water for rinsing.
Draw patient toward the edge of the bed. Remove the
pillow entirely (to rest the muscles of the neck) or replace
it with a smaller pillow if the patient prefers.
Lay a small blanket, arranged in three folds, across the
chest and have the upper end of it held by the patient or
tucked in around the shoulders so that while folding down
the bedclothes to the foot of the bed, the other end of the
blanket may be drawn with it, thus covering the patient.
Then place another small blanket lengthwise on the bed,
rolled close to the patient's side. Draw this beneath the
body and remove the nightdress under cover.
Each part is washed, rinsed and dried separately and the
body is at all times protected by a cover blanket.
In using a wash cloth, take all four corners within the
hand to prevent them dripping on the patient, and wash
with firm, gentle stroke. First bathe the face, wiping the
eyes toward the nose. Then the neck and ears. Then
bathe the arms and immerse the hands in the water and
carefully clean them, using a brush and an orange stick
for the nails, and when bathed wrap the arms in folds of
84 PRACTICAL HOME NURSING
the under blanket. Then proceed to bathe the chest, axil-
lae and abdomen. After drying them, turn the patient on
the side and wash to the waist line, then to the middle of
the thigh, and dry. Turn the patient again on the back
and wash the legs, which can more easily be done by flexing
the knees. Place the feet in the basin of water when
bathing them and use a brush for the nails. Wash the
soles of the feet with firm, steady strokes to prevent tick-
ling and carefully bathe the pubic region unless this has
been done prior to the whole bath.
If alcohol is used, rub it on each part after it is dried.
Powder if desired.
When the bath is finished, remove the under blanket, re-
place the nightdress, draw up the bed clothes, and remove
the cover blankets. Replace the pillows which have been
shaken up and if the bedding requires to be changed, this
should be done at the same time that the under blanket is
In case only one bath blanket can be procured, use it
doubled or substitute turkish towels.
COLD ALCOHOL SPONGE BATH
Uses. To reduce temperature.
1 basin of cold water 1 hot water bag
2 large wash cloths of rough 3 safety pins
material 1 bottle alcohol, 95 per cent.
3 towels Ice bag or cloth for head
Ice (if ordered)
Mix alcohol and water in equal parts.
Method. Prepare the bedding and the patient as for a
sponge bath, except for these details : a rubber sheet should
be put beneath the under blanket so that more water may
be safely used, and a loin cloth is pinned about the hips.
Allow the head to remain slightly raised.
Apply an ice bag to the head, or a cloth wrung out of
cold water and frequently changed. Then remove the
upper blanket. Proceed to bathe the large surfaces of the
body, keeping up friction which, by constant rubbing,
brings the blood to the surface of the body to be cooled.
Let the water evaporate ; do not dry it off. The only part
which cannot be vigorously rubbed is the abdomen or any
Half the time ordered for the bath (usually 15 or 20
minutes) is given to sponging the front of the body; the
remainder is spent on the back with the patient turned on
To remove the patient from the bath. Eemove the
cold application from the head. Place a blanket over the
body and remove loin cloth and under blanket by rolling
them close to the patient's side and slip another blanket in
their place at the same time. Turn the patient on to it.
Draw up the upper bedding and place a hot water bag
near the feet. Give hot broth to drink and at the end of
half an hour remove the blankets and hot water bag, re-
place the nightgown and take the temperature, pulse and
Uses — in general.
To relieve congestion, by increasing general circula-
To draw blood away from the head.
Foot tub and water Pitcher with additional hot
1 rubber sheet water
3 towels Hot water bag with cover
1 blanket Bath thermometer
Foot bath for patient in sitting position. Patient
should recline in a comfortable chair. The bath is pre-
86 PRACTICAL HOME NURSING
pared in a foot tub at a temperature of 105°. Place
the rubber sheet on the floor to protect the rug ; fold the
blanket in half, placing one end under the knees so that
the patient is sitting on it. Then move the tub in posi-
tion, having a thermometer in the water or testing heat
with jour elbow. Lower the feet gently into the water
and cover with the other end of the blanket, lifting one
corner occasionally to add hot water. This should be done
gradually until the temperature reaches 110°. When
mustard is added (one tablespoonful to a gallon of water)
a lubricant should be applied to the soles of the feet to
When finished, withdraw the tub, dry the feet and leave
them wrapped in a blanket or apply a hot water bag for
a few minutes.
Note. Mustard should be mixed to a thin paste in cold
water and thoroughly stirred into the bath.
Foot bath in bed. Flex the patient's knees and turn
the bed clothes back from the foot of the bed over them;
lay the extra blanket into a simple envelope or fold, one
side of which rests on the bed under the tub while the
other is drawn up over the legs and tub. Continue the
bath as described above. It will be found more conveni-
ent to let the tub lie lengthwise on the bed, with the edge8
covered by a folded towel to protect the legs from touching
WASHING THE HAIR IN BED
1 rubber sheet 1 pail
2 bath towels 1 pitcher hot water
3 towels 1 pitcher cold water
Comb and brush Castile soap
Method. Make an improvised Kelly pad by rolling a
large bath towel firmly and placing it in a half circle at
the right hand corner at the head of the bed, leaving the
open part of the circle toward the outside of the bed. Over
this place one end of the rubber sheet and tuck in the cor-
ners under the rolled towel. This forms a depression into
which the patient's head may be placed. Put the other
end of the rubber sheet in a pail on the floor and fold in
the sides to form a trough or tube so that the water used
in washing the hair will be directed downward into the
Make a good lather of soap and wash the hair, rinsing it
in warm water thoroughly two or three times. Lift the
head out of the Kelly pad on to a bath towel and dry with
extra towels. Apply 95 per cent, alcohol to the hair to
assist in drying and rub until thoroughly dry. Separate
the hair into several strands with the fingers and brush each
one free of tangles.
Pediculi or lice cause an eruption on the scalp accom-
panied by constant itching.
Treatment. Saturate the hair with kerosene oil and
bind the head in a cloth for two hours. Then wash the
hair in warm vinegar to soften the eggs or nits, and comb
with a fine comb. After this wash the hair with warm
water and soap.
Larkspur may be used instead of kerosene and followed
by the warm vinegar as described above.
If any nits or eggs are left on the hair, apply warm vine-
gar and comb with a fine tooth comb.
Note. If kerosene oil has been used, precaution must
be taken to keep the head away from lighted gas or any
open flame until it has been washed off.
Arranging a patient's hair. Method. To comb a
patient's hair in bed, draw her as near the edge of the bed
as possible. Provide some covering for the pillow.
Comb very gently, beginning at the end and always hold-
ing the hand between the comb and scalp to prevent pull-
ing. If the hair is badly tangled it may be made some-
88 PRACTICAL HOME NURSING
what easier to comb by rubbing in a little vaseline or alco-
hol at the tangled part. Part the hair and arrange in two
braids. If the patient can sit up even for a short time, the
hair should be left until then to arrange.
The scalp needs to be rubbed frequently and a little
CARE OF THE MOUTH
The mouth requires close attention and care during ill-
ness as any infection from an unclean mouth can easily
affect the mucous membrane all down the alimentary
Infection can also be carried from the mouth to the ear
through the eustachian tube.
A patient suffers great discomfort from an unclean or
sore mouth or tongue, also from an unhealthy condition of
the teeth. The latter frequently causes a sore mouth and
many unfavorable conditions in the body.
Methods of caring for the mouth. Brush the teeth
night and morning and after every meal with a fairly
stiff toothbrush, being sure that the back of the teeth also
are brushed, using toothpaste or an antiseptic solution,
such as listerine or borine, as preferable to powder.
In case of extreme sensitiveness of the mouth or where
difficult to open wide, procure a soft, small toothbrush for
this purpose, or wrap cotton on a stick or on a piece of
whalebone and dip this in an antiseptic solution and then
rub the cotton very gently over the gums and teeth.
When a patient cannot sit up turn the head a little to
one side and have them use a flat basin or an ordinary
soapdish to expectorate in. The mouth should be rinsed
out after food.
To clean the tongue. Take a small wooden stick or
whalebone with the end wrapped in cotton and dipped in
the solution and wash off the tongue with it. If the
tongue is dry and hard apply a lubricant such as :
J 2 parts glycerine
1 1 part lemon juice
g J 1 part alboline
[ 1 part lemon juice
Any of these can be applied with a dropper or a wooden
toothpick with cotton on the end is convenient.
When the patient is on a milk diet, the mouth should be
rinsed out after each feeding with a weak solution of bi-
carbonate of soda, 1 teaspoonful to a glass of water (few
drops of tincture of myrrh may be added).
If the patient wears false teeth, these must be carefully
cleaned and kept in water when not in the mouth.
A little lubricant or oil sprayed or rubbed inside the
nostrils is a simple way of giving relief when they are
dry, or breathing through the nose is difficult.
CARE OF THE HANDS
The hands become uncomfortable unless well cared for
in the time of sickness. They need frequent washing,
especially before and after eating, and if the skin is dry
rub on cold cream or almond cream lotion. Keep the nails
filed short and soft with a lubricant, and use an orange
stick for cleaning them. The cuticle can be rubbed back
with a towel when drying the hands each time.
CARE OF THE FEET
To keep the feet in good condition have them soaked
in warm water at least three times a week, and washed
daily. Some oil, vaseline, or other lubricant can be
rubbed in if the skin and nails are dry and hard. The
nails should be cut straight across, not curved, and where
there is a tendency toward ingrowing nails clip an inverted
disc in the center and scrape the center surface as thin as
possible to draw the nail away from the sides. If the feet
90 PRACTICAL HOME NURSING
perspire too freely, they become tender, sore and chafed,
and there is likelihood of a strong odor. To overcome this
tendency bathe daily with soap and water and then with
salt and water and rub with alcohol and powder. Change
stockings frequently and let air get to the inside of the
PUBBING A PATIENT
There are innumerable times in sickness when rubbing
is needed and if well done gives a great deal of comfort
to the average patient. Regular massage is the science of
exercising the muscles and requires very exact knowledge
and should not be confused with ordinary rubbing : — this
rubbing increases the circulation under the skin and soothes
the nerves by relieving the tension and tends to keep the
whole skin healthy, particularly when normal exercise is
restricted as with the sick.
In order to make a smooth motion, use even pressure of
the whole hand and don't press in with the fingers and
have a little lubricant or powder on hand.
In the extremities, follow the course of the veins, rub-
bing toward the heart and from the head down. For the
forehead rub over the eyes, using the tips of the fingers
lightly and press outward.
For the arm, hold the wrist in one hand and rub up
with the other.
When rubbing the lower extremity stand facing the
foot of the bed and draw the strokes toward you (this gives
your arm freer action). The abdomen is sometimes
rubbed when patient is constipated and the direction
should be up the right side, across the top and down the
To rub the back, have the patient turned toward you
and rub out from either side of the spine and for the
shoulders and lower part of the back rub with circular
motions, making the skin move under your hand. The
back requires frequent rubbing.
PREPARING A PATIENT FOR BREAKFAST
A sick person is usually in no condition in the early
morning to endure exertion, so that the few preparations
necessary before breakfast should be made with as little
effort to the patient as possible.
Take the temperature, if necessary ; the face and hands
should be washed and the .hair smoothed, not arranged,
the teeth cleaned and the mouth rinsed out. Straighten
the bed clothing and have the room tidy. If able to sit up
in bed, place a wrap around the patient's shoulders and a
large pillow or bed rest directly against the head of the
bed for her to lean against, and small pillows arranged
where needed and a stand or table for the tray.
Breakfast itself should be a light meal and attractively
served, to tempt the appetite.
TO GET A PATIENT READY FOR THE NIGHT
If possible let a patient sit up in a chair for a few min-
utes before retiring. Tighten and smooth the under bed-
clothes and brush out any crumbs. See that the upper
bedding is sufficiently loose to be comfortable over the feet
and is drawn up high enough to cover the shoulders when
the patient is lying down, and have fresh, cool pillows.
Give any necessary nourishment, wash the face, hands
and teeth, and brush the hair. Rub the back with alcohol
and powder it. Change the nightdress, and if necessary
for comfort, a small pillow may be placed under the back,
or, if the patient lies on the side, under the abdomen, to
give support. Sometimes a warm bath is given or an
alcohol rub. Darken the room and see to it that there can
be no noise from rattling windows or banging doors.
(Wedges put in windows and doors, or a cloth tied from
the door handle inside to another outside helps to prevent
these sounds.) Leave an extra cover at hand for the
patient to draw over her toward morning if she should
feel cold. Open the windows and use a screen if neces-
92 PRACTICAL HOME NURSING
sary to prevent draughts or streaks of light from outside.
Giving a bedpan. Warm the bedpan first, then turn
the bedclothes slightly back. Have the patient flex the
knees. Raise the hips, draw up the gown and insert the
pan at right angles to the bed, turning it so that it lies in
proper position under the patient. If the patient cannot
raise the hips, have pan in position, flex the knees and with
both your hands raise the hips; hold with one hand and
insert the pan with the other.
Removing bedpan. Flex the patient's knees, raise the
hips, and withdraw the pan in same manner as it was in-
serted. Cover and remove. Turn patient on the side and
wash off the part.
To prevent bedsores and for the comfort of the patient
it is very necessary to raise the hips perfectly clear of the
pan while inserting or removing. If a patient is emaci-
ated, it will be more comfortable to place a rubber ring
partly inflated with air over the bedpan before inserting.
A small pillow or a folded towel should be placed under
the small of the back with the end over the edge of the
What different purposes are tub baths given for ?
Mention points to be considered in giving them.
Describe method of giving sponge bath for cleanliness.
Mention points of difference when giving sponge bath to
Under what circumstances would soda or bran baths be
Describe the method of giving a mustard foot bath.
What results are expected from it ?
What are the dangers of an unclean mouth ?
How can they be avoided %
What effect has rubbing on the skin ?
In what direction are the extremities rubbed ?
Pressure sores are usually spoken of as bed sores, al-
though they can develop under any condition where there
is a constant pressure on a part, as this prevents healthy
This pressure may come: (1) from the body being con-
stantly in one position; (2) from one part pressing against
another; (3) from moisture and unclean] mess of the
skin; (4) from friction from the bed clothes or (5) from
splints and bandages improperly adjusted. Paralytics
and very thin or emaciated patients or those with other-
wise lowered vitality are especially susceptible to this
The most susceptible parts are the lower end of the
spine, the buttocks, hips, heels, knees, ankles, toes, elbows
and ears. When placing or removing a bed pan special
care should be taken to raise the hips sufficiently to avoid
rubbing the surface against the pan.
Prevention of pressure sores. Bathing and rub-
bing. Bathe the parts frequently. Keep the skin dry
and stimulate it by rubbing, using a little lubricant on the
hand and rubbing with a smooth firm touch in circular
motions. This is always to be followed by rubbing with
alcohol which leaves the skin dry, hardened, and less liable
to break down. Then apply talcum or stereate of zinc
Remove pressure. If a patient can be turned, change
the position frequently as the simplest way to remove pres-
sure. If this cannot be done, the pressure must be kept
94 PRACTICAL HOME NURSING
away from the susceptible parts by the use of rubber or
cotton rings, air pillows, or an air mattress.
For the lower part of the back, a rubber ring is neces-
sary. This should be covered with a bandage or should
be slipped into a pillow case. This ring should be only
partly inflated, otherwise it will be hard, uncomfortable,
and may itself cause irritating pressure. In case of a
very heavy patient, two such rings can be used, one on top
of the other, both only partly inflated and tied together by
a bandage or adhesive plaster. Be sure that the part to
be protected does not touch the surface under the ring.
To ease the consequent strain on the muscles, place a pillow
in the hollow of the back. Rings made of cotton and
covered with bandage, or air pillows, can be utilized to
keep pressure off various parts of the body. A hot water
bag partly filled with air makes a good substitute for
such a pillow.
Signs of development of bed sores. If a patient
complains of stinging when rubbed with alcohol, stop the
use of alcohol at once as this sensation indicates that the
skin is nearly broken. Apply stereate of zinc powder or
oxide of zinc ointment over the part. Remove all pres-
sure and rub around the part towards the wound and not
away from it. This will improve the general circulation
at that part.
Always notice the least sign of redness of the skin.
Bed sore wound. Report the first sign of a bedsore
to the physician. When a sore has formed follow orders
as to dressing, etc. It would be treated as any wound, but
particular care must be given to those developing around
the hips and buttocks in order to prevent fecal matter or
urine from infecting them. Remove all pressure.
If the skin is reddened or sore from pressure from
splints or bandages these must be readjusted and the skin
rubbed with alcohol and alum (to harden it) and well
A patient who is constantly sitting in a chair requires
care to prevent pressure sores, liubber rings and air or
soft hair pillows can be adjusted to relieve such pressure,
and the arms of the patient must also be protected in many
cases by the same method. Patients suffering from any
form of paralysis are very susceptible to this danger.
When an invalid is driving or motoring. It is a
comfort to an invalid when driving or motoring to have
an air cushion under the body to ease the strain.
What may cause bed sores ?
What practical means can be taken to prevent them ?
Mention the parts of the body most susceptible to bed
Describe the practical methods for removing pressure.
How may a threatened sore be prevented from developing ?
Why are bed sores difficult wounds to heal ?
EN EM AT A
An enema is an injection of some fluid into the intes-
tines through the rectum.
/ Simple laxative . To stimulate the muscular action of
(.Laxative the intestine
Nutritive To give nourishment
Stimulating ... .To give stimulation
Saline irrigation . To supply fluid to the system and to
cleanse the intestines
Under normal conditions an individual should have at
least one movement a day from the intestines, otherwise
there is a reabsorption of this waste into the system which
acts as a slow poison causing various disturbances. This
is usually regulated by exercise and the proper diet. In
time of illness the lack of exercise and the more con-
densed food taken are apt to make the use of an enema
GENERAL RULES FOR GIVING AN ENEMA
All appliances must be absolutely clean before using,
and thoroughly cleansed afterwards by washing with soap
and water, rinsing and drying.
All tubes, tips or nozzles must be sterilized by boiling,
rubber tubes being left not longer than two minutes in the
Always let the fluid run to the end of the tube to expel
the air, then clamp until inserted. Leave fluid in the
tube and clamp it before withdrawing for the same reason.
A screw may be fastened in the wall near the bed at the
desired height to support a fountain syringe bag. This
will be filled with whatever solution is required for the
treatment. The force of the flow is regulated by the
height of the bag.
Rubber sheet Fountain syringe or irrigat-
Cotton sheet ing can, with tubing,
Towel clamp, and nozzle
Bed pan or commode Soft rubber rectal tube
Lubricant Proper quantity of solution
Glass funnel to be used
The tubing attached to the syringe or irrigator is usually
about five feet long, fitted with a clamp to control the flow,
and is connected with a soft rubber rectal tube by a glass
Position. The patient should be placed on the left
side. This allows the fluid to go higher into the intestines,
because it can follow the natural course of the canal. The
next best position is to have the patient on the back. The
knees should be drawn up to relax the muscles of the
Preparations. Place a rubber covered by a sheet under
the patient, at the same time drawing up the nightdress to
the waist line. Turn the patient on the left side, bending
the knees. Arrange the bed clothes conveniently and
place a towel over the rectum.
Solution used. A solution of warm water and castile
soap (which is non-irritating), 1-3 pints for an adult
or 14 to 1 pint for a child, is most commonly used. The
suds should be removed.
Process. Have the solution in the bag at a temperature
PRACTICAL HOME NURSING
of 105° and hang it two feet above the patient. Lubricate
the rectal tube, expel the air from the tube, clamp it and
insert gently into the rectum. For a high enema, the
tube is inserted about 8 inches ; for a low one, 3-6 inches.
It is easier to retain a high enema than one just inside the
rectum. If there is any difficulty in inserting the tube,
do not force it, but withdraw it slightly and try it again.
If the patient complains of pain while the fluid is running,
stop the flow for a few minutes to allow the gas (which is
causing the pain) to disappear, so that the patient can
retain the additional fluid more comfortably. When the
required amount has been given, withdraw the tube slowly
and press a towel against the anus, or opening of the
rectum. This enema should, if possible, be retained ten
If a bed pan is to be used, turn the patient on the back,
bend the knees, raise the hips and place the pan in po-
sition. Fold the end of the sheet (which is already under
the patient) over the legs to protect the bedding. After
removing the bed pan, turn the patient on her side, wash
off the part carefully with soap and water and dry. Re-
move the rubber and extra sheet and arrange the night-
gown and bedding.
If a commode is to be used, have it convenient to the
bed. Put on patient's stockings, slippers and wrapper,
and assist to the commode. Place a blanket over the legs,
a hassock under the feet, and a low chair in front which
can be used to lean on in case the patient feels faint or
wants to relax the abdominal muscles.
Funnel and rectal tube method. Another ap-
paratus frequently used for a simple enema is a funnel
with a rectal tube attached. In this case, the fluid is
poured in the funnel from a pitcher. This method should
always be used for an enema requiring only a small
amount. Have the fluid ready,— hold the funnel in the
left hand and pinch the end of the tube between the thumb
and the index linger. Fill the funnel, allowing the fluid
to run to the end of the tube. Then pinch the tube at the
funnel end while it is being inserted with the right hand
and control the speed of the flow by pressing the tube with
the finger. If necessary, refill the funnel, being careful to
do so before it becomes entirely empty and pinch the tube
before finally withdrawing it to prevent air being car-
LAXATIVE OR OIL ENEMA
This is frequently used when the patient is very con-
stipated to soften the fecal matter and it consists of 6 to 8
ounces of olive oil at a temperature of 105°. This should
be given as a high enema, very slowly, by means of a rectal
tube and funnel, and may be retained an hour. This is
sometimes followed by a simple enema if not effectual.
This is prescribed when food cannot be taken in the
usual way and, as the large intestine has not the power
to digest but only to absorb it, the food for this purpose
must be predigested. This may be peptonized milk or beef
extracts combined with other ingredients as ordered. The
usual amount is 4-6 ounces at intervals of 4-6 hours
and at a temperature of 100°.
This is given by means of a rectal tube and funnel as
described, but very slowly, almost drop by drop, so that
the intestines will tolerate and retain it.
A simple enema is given once in 24 hours while a patient
is being fed by rectum.
This can be used in emergencies. It is given at a
temperature of 110°-112° and its ingredients are gen-
erally saline solution or strong coffee in a quantity 8-12
100 PRACTICAL HOME NURSING
ounces, or if whiskey is used, from y<% to 1 ounce included
in the total amount of fluid.
RECTAL SALINE IRRIGATION
Normal salt or saline solution is made by adding l 1 /^
teaspoonfuls of common salt to one quart of water and
boiling it. In this proportion, the solution is not irritat-
ing to the surface and is very generally used for all sorts
Articles needed. Beside the usual articles necessary
for giving an enema have ready 6-12 quarts of the above
solution at a temperature of 100° ; also an irrigating bag
with the usual tubing and clamp and, connected to this,
a glass T tube. To one of the arms of this glass a rectal
tube is connected and to the third opening a piece of
tubing 3 feet in length, fitted with a clamp, is attached.
Method of giving. Prepare the patient as for a sim-
ple enema and place a foot tub on the floor beside the bed.
Fill the bag with the solution and hang it two feet above
the patient. Place the tubing to carry off the return flow
in the foot tub, fasten the glass T tube to the sheet with
a safety pin, then introduce the oiled rectal tube and allow
a pint of the solution to pass in, clamp off that flow, and
open the other clamp to let the outflow escape. This is
kept up until the required amount has been given, opening
and shutting the alternate clamps to allow the solution to
run in and out.
Another method of using tubes. Make the same
preparations as above except that in this case two rectal
tubes are used. Connect with the bag in the usual way
and join the second to a piece of rubber tubing to make it
long enough to reach the foot tub. Both tubes exactly the
same length are oiled and inserted together 8 inches into
the rectum, then one is withdrawn 2 inches and kept in
that position while the flow runs steadily in and out at
the same time.
In all cases of rectal irrigation, unless there has been a
normal movement from the intestines, a simple enema is
given before the irrigation, to clear away the fecal matter.
A vaginal douche is given to wash off the surface of the
For the purpose of cleanliness or as a treatment
for continuous heat.
For a simple douche a saline solution may be used or a
boracic acid solution of 1 per cent. ; other kinds, including
strong disinfectants, would be ordered by the physician.
Four to eight quarts should be prepared at a tempera-
ture of 108-112°.
Douche pan Solution
Rubber bag and tubing Sheet
Sterile douche nozzle Towel
Douche nozzles are made of hard rubber or glass with the
holes in the side.
Method of giving. Arrange the patient in position on
the back with the knees flexed and head low ; raise the hips
and draw the gown and place the douche pan beneath, put-
ting a folded towel as a cushion on the seat part of the pan.
Fold the bed clothes partly back over one leg and place a
folded sheet around the other to prevent exposure; wash
off any discharge from the vagina. Have the bag con-
taining the solution arranged two feet above the patient;
expel the air and introduce the nozzle downward and back-
ward about 4 inches, allowing the solution to run in with
a slow but steady flow. In removing the pan after the
102 PRACTICAL HOME NURSING
water is expelled be careful not to spill the contents. Dry
off the part, pull down the gown and let the patient rest.
This is given to wash out the canal of the ear, or for
the application of heat to relieve pain. The solutions most
commonly used are normal saline solution or boracic acid,
2 per cent., at a temperature of 105° or hotter.
Basin Bag and tubing Cotton
Towel Sterile glass tip Solution
Method of giving. Wash off any discharge on the
ear. Have the patient sitting up or at least with the head
raised, and place a basin under the ear. Hang the bag
containing the solution a foot above the head. Hold the
ear backward and upward to straighten the passage and,
after expelling the air from the tube, direct the fluid into
the ear but do not close the opening with the tip as there
must be a space to allow for the return flow. When the
required amount has been given, wipe out any remaining
moisture with a piece of cotton, rolled firmly, and lay
the patient on the affected side to drain out any fluid.
Another method of irrigating the ear is to use a return
flow nozzle which is attached to the bag in the usual way
but with an additional piece of tubing attached to the other
branch of the main tube. This allows for a continual flow
in and out of the ear. The nozzle in this case is placed in
Note. An ear should not be syringed without orders
from a physician.
A nasal irrigation or douche is given to cleanse the nasal
cavity and usually consists of normal saline solution or
boracic solution, 2 per cent., at a temperature of 105°.
1-2 quarts of solution Basin
Irrigator bag and nasal Towel and handkerchief
Method of giving. Arrange the patient sitting up,
with the head bent down over the basin and the mouth
open, as the breathing is to be through the mouth the
entire time of the treatment. Warn the patient not to
turn the head on the side. Hang the bag so that the lower
part is on a level with the patient's head (to prevent too
much force). Insert the nasal tip in both nostrils alter-
nately and the fluid running through will wash the cavity.
The position of the patient in this case is important in
order to prevent discharge being carried into the Eusta-
chian tubes which extend from the throat to the ear and
through which infection is easily carried.
These are ordered for cleansing the throat or reducing
inflammation by a continuous flow of hot salt solution.
About 4 quarts can be used at a temperature of 108° or
hotter if the patient can stand it.
Solution to be used Basin
Bag and tube Towel
Any tube with an opening in the end can be used. The
best is a glass tube 8 inches long with a curve of two inches
more at one end.
Method of giving. Have the patient sitting with
head bent down over the basin and place a towel around
the neck. Hang the bag 2 feet above the head, insert the
tube well back on the top of the tongue and let the water
flow in and out, keeping the mouth open and not breath-
ing through the nose.
104 PRACTICAL HOME NURSING
This is given to allay inflammation or to cleanse the
eye from discharges. Boracic solution, being non-irritat-
ing, is generally the fluid used, 2-4 per cent, at tempera-
ture of 100°.
1-2 pints of solution
Sterile eye dropper
Small vessel (to catch dis-
Method of giving. Wipe off any discharge on the eye-
lid first with a swab of cotton wet in the solution. Then
open the lids with two fingers, taking care not to press on
the eyeball but on the bone above the eye, and drop the
fluid in with a dropper or a piece of cotton, washing from
the inside out to prevent infection being carried to the
other eye. If both eyes are affected, wash each one sep-
arately, that is, with separate cloths. In fact, a fresh piece
of cotton should be used for each application.
If an eye cup is used, fill it half full with the solution,
place firmly against the eye, throw the head back and
have patient open and close the eye several times while
the fluid is still against the eye.
What is an enema?
Name different kinds of enemata.
In what position would patient be placed for this treat-
Describe the process of giving a soap suds enema.
What different purposes are saline irrigations of the in-
testines used for ?
Describe methods of giving same.
Name important points in process of irrigating an ear.
What position should patient be in for nasal irrigations ?
— why ?
How wash out an eye?
Why is absolute cleanliness important in all these treat-
What is a vaginal douche given for?
State the amount — the solution used.
External applications are used frequently in the care
of the sick, in various forms and for different reasons, and
must always be applied with the greatest care. They con-
sist of dry heat, moist heat, poultices, counter-irritants,
and cold applications — moist and dry.
This is used
(1) to give warmth to the body and in that way
(2) to promote free perspiration,
(3) to relieve pain.
Heat relieves pain by increasing the circulation of the
affected part, thus removing the congestion which, by pres-
sure on the nerves, causes pain in many cases.
Dry heat. For this purpose may be used electric pads
or hot water bags. With the former, while they are
most convenient, there is some danger attached to their
use and they must be constantly watched as the heat in-
creases gradually and is liable to become too hot and burn
the part. Also be sure that the pad is in a thoroughly
good condition and that the insulating material is intact
to prevent accidents by fire.
Method of filling a hot water bag. A hot water
bag is the most generally used method of applying dry
heat. Have the water below boiling point — and not above
180° — and half fill the bag with it. If the water is
poured in by means of a funnel it goes directly into the
bag without injuring the rubber cenient at the neck of the
bag ; it is also the most convenient way of filling it. Screw
on the stopper securely and invert the bag to test for leak-
age, then place it in a washable cover.
The air in the bag can be left if it is used for such a
purpose as against the feet, but in order to make it pliable
and adjustable, the air should be expelled by pressing it
out before the stopper is inserted.
If this method of dry heat is to be used over a very
sensitive part, lessen the weight by putting very little
water in the bag.
When not in use, a rubber bag should be filled with air
which distends the sides and prevents them from sticking
together. Have the rubber washer on the stopper replaced
by a new one if worn thin.
Metal or crockery bottles are durable but not as con-
venient, and can be used only at the feet or to warm a cer-
Dry heat can also be applied by means of hot salt bags,
the salt being heated before placing it in the bag, or by
Moist heat. Moist heat is more penetrating than
dry heat and by relaxing the muscles and tissues, quickens
the circulation and thus eases pain. For this purpose are
used: (1) hot or warm baths, (2) fomentations, (3) poul-
tices, or (4) hot compresses.
HOT FOMENTATIONS OR STUPES
By this means, moist heat is applied continuously for a
certain period of time, to various parts of the body. They
are most commonly used on the abdomen to relieve pain
arising chiefly from an accumulation of gas which distends
the abdomen and causes a great deal of distress. In such
108 PRACTICAL HOME NURSING
a case a rectal tube is sometimes inserted into the rectum
and left there during the treatment to make a channel
through which the gas passes off more readily. The free
end of the tube should be in some receptacle to receive any
fecal matter discharged with the gas.
2 basins Lubricant
A blanket Stupe cover
Large towel Stupe wringer
% yd. gauze Turpentine if required
3 pieces flannel Boiling water
Some apparatus for heating water near at hand
For the cover, a layer of flannel and oil silk fastened
together will be found most serviceable but flannel and
brown paper used in the same way make an excellent sub-
stitute. Such a cover should be light in weight and as
air-tight as possible and much larger than the area to be
A stupe wringer is made with a piece of coarse toweling
about V2 yard long with a two-inch hem turned in at
either end. Two thin, round sticks longer than the width
of the towel are run through the hems. The stupe can
then be laid on the toweling and wrung nearly dry with
the help of the sticks, turning them in opposite directions.
In place of the wringer, a crash towel can be used in much
the same way.
Method of applying. Turn back the bedclothes to
below the abdomen, replacing them with a blanket. Draw
the gown up out of the way and arrange a tightly rolled
large towel around the abdomen in a circle to prevent the
bedding getting damp. Oil the surface of the abdomen
and protect with a piece of gauze. On top of that place the
stupe cover and fold the blanket back from that part.
EXTERNAL APPLICATIONS 109
Place the flannel inside the wringer or towel and dip this
into a basin of boiling water (which should be at hand)
leaving the ends of the wringer outside the basin where
they can be handled. Wring the flannel very dry by
twisting the two ends in opposite directions. Place the
wringer in an empty basin, remove the flannel, shake
slightly, draw the gauze protector away and apply the
flannel stupe directly to the skin, passing it under the
stupe cover. These flannels are changed every five min-
utes and always under cover. This treatment is usually
kept up from half an hour to an hour. After removing
the heat, dry or oil the skin and cover with flannel or a
If turpentine is ordered, this can be put into the water
in the basin — about 1 teaspoonful to a quart of water —
or a safer way to prevent blistering of the skin is to mix
one part of turpentine with three parts of oil and wipe this
over the surface before applying the stupe. However, this
should not be applied more than three times during the
Fomentations are also applied over the chest, throat or
other parts of the body by the same method.
A hot compress. These can be made of gauze or thin
flannel wrung out of hot water, the temperature of this
varying from 116° to 120°, and applied to the part, and
changed every two minutes. No cover will be needed.
This treatment is kept up usually from half an hour to an
hour. If there is any discharge from the part, such as
from an eye, a fresh compress should be used each time.
A convenient arrangement is to have a chafing dish near
the bed and the compress kept in hot water there, ready
Poultices can be made of any non-irritating substance
that will retain heat, the size and shape depending upon
PRACTICAL HOME NURSING
the surface to be covered. The poultice is put in gauze or
thin muslin and will require a cover (as described in
stupes) to retain the heat.
Flaxseed Sauce pan Cover
Water Gauze Lubricant
Method of applying flaxseed poultice. Flaxseed or
linseed meal is generally used for poultices as this contains
oil which makes it penetrating and more effective. For
a poultice about six inches square, allow 1 pint of water,
% lb. of flaxseed and % yd. of gauze. When the water is
boiling, add enough of the meal to make a paste which
will drop semi-solid from the spoon. Then continue the
boiling from 3 to 5 minutes, beating constantly. This in-
corporates it with the air which makes it light in weight,
while at the same time it thickens with boiling. A half
teaspoonful of bicarbonate of soda added during the beat-
ing will help to make it still lighter.
Spread this poultice about an inch thick on the center of
the gauze, folding the extra gauze over from side to side,
then from the ends, placing one inside the other to make it
secure. Carry this with its cover on a warm plate or
tray, to the patient's side.
Adjust a binder to hold it in place under the part to be
poulticed, leaving the ends outspread. Oil the skin, test
the poultice for heat with the back of the hand, and apply
it directly to the part, slightly raising the corners of the
poultice from the skin until the patient becomes accus-
tomed to the heat. Place the cover over this and adjust
the ends of the binder to hold it in place. This will
usually keep warm about an hour, and if necessary to con-
tinue the treatment, a fresh poultice must be ready before
the other is removed. Afterwards dry and oil the skin
and keep the part well covered with a warm protector.
Mustard is sometimes added to such a poultice in the
proportion of 1 part of mustard to 8 or 10 of flaxseed,
it should be dissolved in a little cold water and added after
the poultice is cooked, and well beaten into it.
Starch poultice. This is made by dissolving laundry
starch or corn starch in cold water and then adding it to
boiling water which thickens it. It is spread on a muslin
surface and when cool enough, applied directly to the part.
This is often used for its soothing effect on an irritated
Bran poultice. Bran is placed inside a bag, dipped in
boiling water, wrung out in a cloth and applied to the part,
and kept covered.
These are agents which, by their irritant action, increase
the flow of blood to one part thus attracting it from an-
other, thereby relieving pain by reducing congestion in
any one place.
The simplest counter-irritants are hot water bag, mus-
tard paste, tincture of iodine, turpentine and camphorated
Mustard plaster or paste. These are made with mus-
tard, flour and water or, if the skin is very sensitive to
blistering, the white of egg can be used instead of water.
For a paste six inches square about 6 level tablespoonfuls
of the material will be needed and a half a yard square of
Table for mustard paste.
Medium 1 part mustard to 5 parts flour
Stronger 1 part mustard to 4 parts flour
Weaker 1 part mustard to 8 or 10 parts
(for children) flour
112 PRACTICAL HOME NURSING
Method. Mix mustard and flour together dry, add
tepid water to make a paste ; spread this on the center of
the gauze leaving a margin all around the paste. Then
fold over the extra gauze from side to side, and from end
to end, fastening one inside the other securely. Place
this on a warm plate to remove the chill from the surface,
before bringing it to the patient.
Method of applying. Oil the surface of the skin and
apply the paste, and hold in place with a light binder.
This is usually left on from 10 to 20 minutes. Guard
against burning by raising the edges of the plaster and
looking at the skin which should be red, but not a dark
red. After removing the paste, wipe the skin with a soft
cloth or wash over the surface to prevent the mustard oil
from further action on the skin. Then apply cold cream
or vaseline, or simply powder, and place a smooth, soft
cloth over the part.
Mustard leaves. Mustard leaves can be obtained
ready for use. They are made of mustard in combina-
tion with a substance that adheres to a muslin foundation.
To apply, dip the plaster in tepid water for a minute and
after oiling the skin, place this on it, leaving it there for
about 10 or 20 minutes or until sufficiently red. After
removing, wipe off the skin and oil the surface as de-
Tincture of iodine. This is applied to the skin by
brushing it over the surface with a camel's hair brush, or
a piece of cotton attached to a small stick. If too much
or too strong iodine is put on the surface and burns se-
verely, wash it off with alcohol.
Note : Tincture of iodine must always be fresh or the
alcohol in which it is dissolved may have evaporated and
left too large a proportion of iodine.
Liniments. Liniments and various oils are applied
EXTERNAL APPLICATIONS 113
to the skin with a piece of cotton, and then rubbed in by
friction with the hands.
Ointments can be applied in the same way or they may
be spread on muslin and placed on the skin, and kept there
by a bandage or strips of adhesive plaster.
Cold is employed to allay inflammation, to relieve pain,
to keep the blood from congesting in any one part, and is
used in the form of ice bags or cold compresses, and these
kept continually cold.
Ice bag. Ice bags are usually made of rubber, fitted
with a metal screw top. They should be about half filled
with chopped ice and the air pressed out, then wrapped in
a musliu or gauze cover to prevent over-chilling or freezing
the part to which applied. The ice should be constantly
replenished to prevent their getting warm.
To relieve the weight of the ice bag. If the weight
of the bag is uncomfortable, it can be arranged so that
the cold surface rests on the part without the pressure.
If to be placed on the head, a piece of tape can be tied
around the metal top and adjusted to allow the bag to
hang from the top of the bedstead and just touch the
head ; or if applied on the knee, for instance, a support of
some firm kind can be placed on either side to support
the sides of the bag, letting it barely come in contact with
Care of bag. After using, dry the inside of the bag
thoroughly and screw on the metal top with its rubber
washer, leaving sufficient air to keep the sides from stick-
114 PRACTICAL HOME NURSING
Cold compress. Fold two pieces of gauze or thin,
soft muslin in the required size, with the edges folded in-
side. Have a basin nearby in which there is a large piece
of ice and some water. Soak the compresses in the water
and cool them on the ice, applying them alternately to the
part — one being constantly on the ice.
Compresses for the eyes. In this case, if there is
any discharge from the eyes, use a fresh compress each
time. For this purpose the gauze is usually cut in oval
shape, larger than the eyes and % inch thick, and can be
chilled and changed as described above. Sometimes the
treatment calls for cold and hot compresses to be applied
For what reason is heat applied ?
How does it relieve pain ?
How does cold relieve pain ?
Describe common methods of applying heat.
How may cold be applied to a part ?
How apply hot fomentations to abdomen ?
What danger to patient from hot applications ?
How avoid this danger ?
FOR THE COMFORT OF THE PATIENT
Amongst the little details that go to make up the sum
comfort of the patient a few of the most essential may be
considered in the following suggestions :
Change the patient's position frequently and use a foot
rest to prevent strain on the muscles.
Have the patient's person and surroundings clean. Give
an extra alcohol rub in hot weather.
Keep the room quiet and cool and have the bed comfortably
made and bed clothes loose enough over the feet.
Give treatments with quiet confidence. Do it quickly and
quietly and concentrate your mind on doing it.
Serve food and drink attractively, prepare and season it
in as many different ways as possible.
Be cheerful and resourceful yourself and keep the sea
smooth. Answer the patient's questions in a satisfac-
tory way and not evasively. Anticipate harmless de-
sires of the patient and study her or his likes or dis-
likes. Know when you have done enough and don't
fuss over it and never try to entertain too much.
Leave the patient sometimes alone.
Be interested in the patient's personal responsibilities.
Try to prevent small household worries from reaching the
Do not become careless in detail during convalescence.
Have the room darkened for the patient to rest for an
hour a day.
Medicine may be given by mouth, through the skin or
by rectum. It is usually in the form of fluids, pills, pow-
ders, tablets, or capsules; also medicated ointments are
applied externally or suppositories are inserted in the
Dry Measure Fluid Measure
60 grains .... 1 dram 60 minims 1 dram
8 drams .... 1 ounce 8 drams 1 ounce
(480 grains ....1 ounce) 16 ounces 1 pint
2 pints . . 1 quart
4 quarts 1 gallon
1 teaspoonful . ., 1 dram
1 tablespoonful % ounce
1 glass (if full) 8 oz.
2 glassfuls 1 pint
General rules for giving medicine.
1. Always read the label twice, once before preparing
the dose and again before giving it to the patient.
2. Have the medicines fresh and clearly labeled, and
keep them in a safe place.
3. Medicines should be given in the exact quantity and
at the intervals ordered, but if for any reason (such as a
patient's being asleep) the dose is delayed, allow the
usual interval between that and the next dose. For ex-
ample, medicine due at 12 o'clock, 3, 6, etc. may be given
at 1 o'clock if the patient awakes then, and after that at 4,
7, 11, etc. Those ordered before meals are usually given
15 minutes beforehand and those ordered after meals about
15 minutes afterwards.
In giving fluid medicine, shake the bottle thoroughly,
wipe off the mouth of the bottle and pour the liquid from
the side opposite the label so that it is kept clean and
there is no danger of obliterating the directions. Measure
fluids accurately by a minim dropper or a graduated glass,
and dilute 2 to 3 times unless otherwise directed.
Ice held in the mouth before giving oil or any dis-
agreeable medicine dulls the sense of taste.
Tablets, powders and capsules should be placed on the
center of the tongue and followed at once by a drink of
water to wash them down. In some cases, tablets are
dissolved in water, or before being given are placed in a
piece of bread or in a spoonful of jelly in order that they
may be swallowed more easily.
Among the most used common classes of medicines are :
tonics (to tone up the parts, such as blood, nerves, stomach,
etc.) ; stimulants (to improve heart action) ; sedatives
(to quiet the nerves or ease pain) ; emetics (to cause vom-
iting) ; and cathartics (to stimulate the muscular action
of the bowels and produce a movement).
COMMON HOUSEHOLD STIMULANTS
(To be used in emergencies)
Stimulants may be given internally by mouth or rectum
or by inhalation. For inhaling, ammonia salts may be
held to the nose, taking care not to spill any of its fluid
which would burn the patient, nor to hold the bottle too
near the face. A handkerchief saturated with aromatic
spirits of ammonia may also be held to the nose with good
effect, or plain ammonia used in the same way.
Stimulants which can be given internally are :
118 PRACTICAL HOME NURSING
Whiskey or brandy — 1 tablespoonful diluted in at
least % as much hot water.
Aromatic spirits of ammonia — Y2 to 1 teaspoonful in
2 tablespoonfuls of cold water.
Coffee, strong and clear, from % to 1 cupful (the stimu-
lant is caffeine).
Extract of coffee, 1 tablespoonful to a cup of boiling
Tea, strong and clear (the stimulant is theine).
Ginger tea, made with 2 tablespoonfuls of powdered
ginger to 1 cup of boiling water, steeped and strained ; or
syrup of ginger, 2 drams in % cup of water.
No attempt should be made to administer stimulants or
other medicines by mouth unless a patient is fully con-
scious, except aromatic spirits of ammonia in very small
doses, which can be absorbed by tongue.
Coffee and alcoholic stimulants may be administered by
(See Enemata, page 99.)
These are given to cause vomiting. The common
emetics are :
Strong salt and water (3 teaspoonfuls of salt to 1 glass
of water which makes it sufficiently irritating to
produce the desired effect).
Mustard and water (1-2 teaspoonfuls of powdered mus-
tard to a glass of water).
Syrup of ipecac ( Vi to 1 teaspoonful, taken undiluted).
Running the finger down the throat will frequently pro-
duce vomiting without emetics, or warm water given con-
tinually until vomiting is produced.
This class of medicines is given to stimulate the
muscles of the intestines and cause a free action from
them. Some cathartics produce the effect slowly and
these should be given at night. Others, producing a quick
effect, are given in the morning. Of this latter class,
castor oil is most frequently ordered in doses of from 1
teaspoonful for an infant to 3 tablespoonfuls for an adult.
As this has a very nauseating taste, it must be carefully
prepared to enable a patient to take and retain it. It can
be more easily taken in any ice-cold fluid, even ice water,
or ice water and lemon juice, or whiskey. Pour this in a
small glass, rinsing it around the edge first ; then pour the
oil, also cold, in the center and the oil will thus be kept
intact. Swallow quickly and the oil goes down on the
water easily; then take some strong flavor in the mouth,
such as peppermint and lie down to prevent nausea. For
a child, the oil can be placed in the same way on top of a
little cold fluid in a spoon ; then place the spoon well back
on the tongue and hold it there until its contents are
swallowed. This prevents closing the teeth and giving an
opportunity of spitting the oil out. Olive oil in the same
quantity may be substituted for castor oil.
Calomel is another cathartic frequently prescribed, and
usually in doses of from 1 to 2 grains. This may be
given in one dose or in /i grain doses every 20 minutes
with water each time until the required amount has been
taken. Five grains of bicarbonate of soda with each dose
helps prevent irritation in the stomach and consequent
nausea. Calomel is given at night and is invariably fol-
lowed the next morning by a cathartic such as magnesia,
or any of the laxative mineral waters. Food should not
120 PRACTICAL HOME NURSING
be taken for 1 to 2 hours after this second laxative and
then only a hot drink, as otherwise the patient will become
Other kinds of cathartics are in the form of pills, cap-
sules, tablets or fluids and these would be given at night
as their action is slow.
Suppositories are also used to cause a movement from
the intestines ; they are cone shaped substances made of
cocoa butter, gluten or glycerine and are placed in the
To insert a suppository, oil both it and the little finger
and push it far into the rectum.
Medicated suppositories are used as a medium for in-
troducing drugs into the system.
ACIDS AND ALKALIES
These are substances that counteract the effect of each
other and neutralize.
Soda and water (1 teaspoonful to 1 glass).
Listerine or borine diluted % with water.
Water with 10 drops of alcohol to a glass.
Boracic acid, saturated solution or diluted, as desired.
Bicarbonate of Soda
f Lemon juice 2 tbsps.
-< Glycerine 2 tsps.
[ Water % glass.
'Lemon 4 tbsps.
Glycerine 1 tbsp.
Water % glass.
„Soda % tsp.
Very hot saline solution.
f Vinegar 1 part.
I Water 4 parts.
Mention important points in the giving of any medicine.
How guard against making a mistake in giving a medi-
Name stimulants that could be used for inhaling.
Mention common emetics.
Mention common stimulants.
How prepare a dose of castor oil for adult — child ?
What could be used for a mouth wash ?
What could be used for a gargle \
122 PRACTICAL HOME NURSING
SUGGESTIONS FOR CONTENTS OF A CONVEN-
IENT HOUSEHOLD MEDICINE CLOSET
Whiskey or brandy
Aromatic spirits of ammo-
Baume Analgesique (to rub
on for pain)
Magnesia granules (effer-
Syrup of ginger
Syrup of ipecac
Essence of peppermint
Bicarbonate of soda (bak-
Solution of boracic acid
Glass jar of sterile water
Cold cream and Pond's ex-
tract (equal parts)
Oxide of zinc ointment
Small package of sterile cot-
ton and gauze
Sterile gauze bandages, 1
and 2 inch widths
Roll of adhesive plaster
Hot water bag
Fountain syringe bag or an
enamel irrigating can
Tubing and tips for syring-
A measuring glass
A dropper and eye cup
Glass drinking tube
Roll of old flannel and linen
Observation of symptoms. One of the chief respon-
sibilities in connection with nursing the sick is that of
training the mind to acquire the habit of observing
changes that occur in the patient's condition. Nothing is
too trivial to notice. Slight changes may give warning of
a serious condition approaching which if discovered early,
might prevent acute developments later. State the facts
in regard to observations as clearly and accurately as
possible to the physician.
The mind must be alert and keen to do this well and to
have an understanding of the patient, and the conditions
that normally surround her. These changes are usually
spoken of as symptoms which are classified as follows :
Subjective are those realized b} r the patient alone, such
as pain, headache, nausea, chilliness, defects in hearing or
Objective are those visible to the onlooker, such as the
position taken, the color and general appearance.
Constitutional are those which affect the whole body,
for example, fever.
Local are those restricted to any special part, as a
swollen knee, a sore throat, etc.
Symptoms may indicate either a state of the body,
mind or nerves and their severity usually increases to-
wards night. The increase or decrease of strength from
day to day is indicated by small things that need close ob-
servation: was the patient less tired after sitting up to-day
than yesterday? Could she walk a longer distance to-
124 PRACTICAL HOME NURSING
day ? Did she seem less nervously tired ? Was the voice
stronger or weaker \ Was the attitude of mind more de-
pressed or cheerful ? Her nervousness less apparent ?
Was the attitude of the body alert, tense or relaxed '( Had
the appetite improved and was there loss or increase of
Pain. It is difficult to define suffering or pain, or to
report on it, because the patient only can tell the severity
or character of it. Some bear pain almost stoically, while
others, having less power of endurance, grow restless and
nervous and sometimes magnify to themselves the degree
of their suffering.
Notice the expression of the face, also the position
taken, for a patient almost instinctively takes that which
gives the most comfort : — when the pain is in the abdo-
men, the patient will draw up the legs toward the body to
relax the muscles and relieve tension ; if the pain is in the
head, this is instinctively raised up to prevent too much
blood going there and causing pressure. Notice if sup-
porting an injured or aching part or elevating it, give
relief and if the pain is darting or piercing, if there are
intervals of relief, or if it is a steady ache. A pain the
patients complain of as " boring " is usually the result of
pressure and needs the removal of that pressure to ease it.
It is important to observe how pain is affected by heat or
cold, rest or motion, such as rubbing, or by the lessening
of light and sound. Surface pain is increased by light
pressure; deep-seated pain by deep pressure.
Sleep. During illness, sleep is more or less unnatural,
and the result of loss of sleep is felt on the heart action as
normally it beats slower during sleep, and this reacts on
the system generally. Some of the particular points to
notice about a patient's sleep are: the actual time if pos-
sible — as a patient is not a good judge of this ; also if it
is sound, continuous and quiet or if the patient is restless,
waking up often, and talking or muttering. Another
point to be noticed is whether the breathing is through the
nose or mouth, and if the latter, it should be reported ;
also if the eyes are closed or partially opened. Patients
are usually not waked for food or medicine, but this de-
pends upon the physician's orders. The return to natural
sleep is often a turning point in an illness, and is always
a favorable symptom, and everything should be done to
induce sleep. Quietness and darkness generally encourage
it and for further suggestions, refer to treatment on in-
somnia (page 137).
Position. Even when not considered in connection
with pain, the position taken by a patient is important to
notice. When there is distress from various causes in the
abdomen, patients will draw up the knee and lie either on
the back or on the side as this relaxes the muscles and re-
lieves the tension. When pressures give relief, as in colic,
they will lie over on the abdomen. If a patient lies on
the back with no desire to change the position, it is often
a sign of extreme weakness and in that case, the patient
must be moved on the side at intervals to keep the circula-
tion active in all parts. Lying continuously on one side
may indicate local disease. Frequently in disease of the
lungs the patient lies on the affected side to leave the other
free and it is a sign of improvement when a turn can be
made over to the other side. The position on the right
side is often taken in order to leave the action of the heart
free. When there is difficulty in breathing a patient is
not always able to lie down and should be supported com-
fortably. Notice the position that eases and in which the
patient can sleep best. For methods of supporting with
rests and pillows see page 71.
Appetite. The appetite can only be considered in con-
nection with other symptoms and is more or less allied
with the condition of digestion or indigestion. Sometimes
126 PRACTICAL HOME NURSING
patients are considered to have no appetite when all that
they need is food that they like. Observe closely what
leads to loss of appetite, it may be only over fatigue,
either physical or nervous or, as the result of depression,
and the patient doesn't want food, or only picks at it. In
acute illness from fever and various causes, the appetite
fails just as other parts of the body are affected. This is
often from the exhaustion of illness and the effort required
to take food. Notice if the appetite improves as the
strength does, and whether the desire for all food is lost or
if certain kinds appeal to them.
The secretion of digestive juices is stimulated through
the nerves by taste, smell, sight ; and the manner in which
food is offered to a patient has a great deal to do with the
appetite. A loss of appetite is also due to lack of digestive
juices, or to the lack of certain constituents in them. In
this case, tonics are given to overcome this condition and
to restore the appetite.
Thirst should be noted as it defines a lack of fluid in
the blood or tissues.
Skin. The color of the skin varies in disease : pale as
in fainting; red or flushed with fever; yellow as in jaun-
dice; or bluish when the blood is very much congested.
Notice any rash or eruption and how it spreads and if
the skin is dry or moist and if the nails are soft or hard ;
whether there is any sign of puffiness of the skin (this
often shows under the eyes or in the feet and legs and
comes from an excess of fluid in the tissues). Also no-
tice any swelling of the abdomen or any other parts such as
the glands, and any indication of redness, chafing or ten-
derness. A patient may complain of an itchiness on the
surface of the skin when there is no rash to be seen. Any
of these conditions should be reported carefully to the
Tongue, mouth and breath. The condition of the
tongue gives information as to the state of the digestive
organs particularly. It is important to notice if it is dry
or moist, furred and coated, if the edges and tip are red
or sore (making it painful), and if swollen. If it is be-
coming better or worse and if there are any signs of irri-
tation on the surface of the mouth, or in the throat, and
if there is an unpleasant odor from the breath. This
usually arises from the condition of the stomach, unhealthy
teeth, or from a catarrhal condition of the nose or throat.
Feces. It is important to observe in regard to the feces,
whether they are dry, hard, constipated, or if they show
a tendency to soft, watery stools ; and if there is any evi-
dence of undigested food or unnatural color. Also note
the frequency of movement and if accompanied by pain or
Urine. Notice the frequency of passing urine and if
there is any distress in connection with this, the color, the
amount in twenty-four hours, and if it is clear or shows
evidence of any sediment.
Circulation. Observe if there is a tendency toward
chilliness or if the hands and feet are apt to be cold.
Temperature, respiration and pulse. Notice if the
temperature varies from normal, either above or below and
if the variation is continuous; the rate of the pulse and
its character — whether strong and regular, or weak, also
if the breathing is difficult or noisy and if it is eased by
the head being raised ; if there is any cough, and whether
this increases at night and is attended with expectoration
(and the character of the sputum) ; if the cough is loose,
dry, hacking, hoarse or comes in paroxysms, and if it
causes any pain.
128 PRACTICAL HOME NURSING
Muscular weakness. Sometimes after an illness there
is more or less weakness and in some eases paralysis of
the muscles. Watch carefully for any sign of lameness
or dragging of the feet, or lack of strength in the muscles
of the arms; also any signs of twitching or unnatural
movements of the muscles 4
Bedside notes. It is much safer to record in writing
the necessary points in regard to a patient's condition. It
is an easier method, more reliable, more accurate, than try-
ing to remember them, and the physician needs the neces-
sary facts about the condition in a condensed way. In
keeping bedside notes, state the facts clearly, give definite
amounts as far as you can. Among the usual points are
temperature, pulse, respiration, diet, sleep, medicine given,
number of stools and amount of urine. Forms for bedside
notes can be easily obtained at any drugstore and charts
can also be obtained for recording the temperature in case
of a persistent fever.
SPECIAL CAKE IN CONDITIONS RELATING TO THE FEMALE
The female generative organs lying in the pelvic
cavity consist of two ovaries each about an inch and a
half in diameter in which the ovum or germ of life is
secreted, and from these extend two Fallopian tubes
about four or live inches long to the uterus which lies in
the center of the cavity. This is also a small organ, 3-4
inches long, 2 inches wide and 1 inch thick, composed of
strong muscular tissue which enables it to expand during
pregnancy and contract again afterward. Its function is
to receive the ovum and, if the ovum becomes fecundated,
to retain it during its development. The uterus is sus-
pended by ligaments, is not attached to any bone and lies
between the bladder and rectum. The vagina is the pass-
age leading from the outside to the uterus. This is lined
with mucous membrane and like all such membranes is
susceptible to infection and to irritation from uncleanli-
The general health of a woman depends largely on the
healthy condition of these organs as they are so closely
allied to her nervous system. Constipation is apt to cause
pressure on the uterus owing to its position which is di-
rectly over the rectum, and is particularly harmful to a
Development of the generative organs. The devel-
opment of these organs, spoken of as the time of puberty,
commences at about fourteen years of age and they function
until about fifty years of age. During that period at in-
tervals of about one month, the ovaries develop and dis-
charge an ovum which is passed by the tubes to the uterus
130 PRACTICAL HOME NURSING
and simultaneously a temporary congestion of the uterus
occurs, the result of which is known as menstrual discharge,
lasting for a few days. For the first day during that
period there is consciousness of additional weight for which
reason no very active exercise should be taken nor should
too much physical or nervous strain be borne by a woman
at such times.
SPECIAL CARE OF THE SICK DURING
This care is largely precautionary. Any symptoms
of disease are likely to be aggravated and the patient may
feel a little depressed. There is also sometimes loss of
appetite. Omit general baths for a couple of days so as
pot to draw too much blood to the surface when it is needed
for active circulation internally. Keep the patient quiet
and free from worry. Restrict the diet somewhat and
unless there is a free action of the bowels give an enema.
As headache is a frequent complication, prevent glare or
direct light or too much strain on the eyes from reading.
There may be various indirect reasons for this pain rela-
tive to unnatural uterine conditions, also nervousness, etc.,
but actual pain is usually due to congestion inside of the
uterus which prevents free circulation, thus causing pres-
sure on the nerves with consequent pain. Constipation is
a common cause for such congestion on account of the posi-
tion of the rectum under the uterus which brings pressure
on that part. Another reason lies in the chilled blood re-
turning to the body when the feet have been cold or wet
for any length of time.
Treatment. Heat applied is the chief treatment.
This may be applied most directly to the uterus by giving
a simple hot enema and after a movement has been induced,
continue with a very hot low irrigation to increase the
FEMALE GENERATIVE ORGANS 131
circulation in the rectum which will affect that of the
uterus. Keep the patient in bed if possible with knees
flexed to relax the muscles and place a hot bag at her back
and feet and another over the abdomen, or hot fomenta-
tions may be applied. (See page 107.) A mustard foot
bath is an effective means to increase general circulation.
Give hot drinks ; ginger tea is excellent in this case as is
also hot tea or coffee. If the patient is nauseated apply a
mustard paste to the pit of the stomach.
Suggestions for preventing pain. If there is a ten-
dency to having pain at this time, try and prevent consti-
pation (see page 133) before the period is due and relax
the muscles by a warm bath. Keep the feet warm and
restrict the usual diet a little.
CESSATION OF MENSTRUATION
Menstruation ceases when the ovaries become inactive
and the extra amount of blood which had been sent to and
utilized by the generative organs during the period of
active function is then distributed to the general circula-
tion and during the period (for some years) of this read-
justment, many uncomfortable sensations are experienced
such as sudden flushes, etc. Also the effect on the nerves
is very noticeable and care should be taken to avoid physi-
cal or nervous strain, or to become even overtired, to keep
in the fresh air a good deal and occupy the mind with
some new interest.
Any unusual discharge from the vagina should be re-
ported and the usual treatment for such a condition would
include a vaginal douche, directions for which are given
on page 101. For treatment of hemorrhage from the
Uterus (See "Emergencies," page 148).
132 PRACTICAL HOME NURSING
Positions for examination or treatment. For exam-
inations or treatments of various kinds patients are placed
in definite positions, and among the most commonly used
Dorsal position. Patient is placed on the back, head
low, and knees flexed, and the legs are draped with a sheet.
Sims position. Patient lies on the left side, with the
left arm extended out at the back, head low. The left leg
flexed, the right leg flexed with the heel almost touching
the knee of the left leg, and legs are draped with a sheet.
Knee and chest position. The patient kneels with the
chest resting on the bed and the knees flexed at right angles
to the body.
2STame the female generative organs.
What is the function of the ovaries ?
What care would a patient require during menstruation?
Mention causes for painful menstruation.
How relieve this condition ?
How arrange a patient in the Sims position ?
How arrange a patient in the Dorsal position ?
MINOR ILLNESSES AND DISORDERS
Headache is a symptom of importance in disease and
it may also be caused by slight digestive disorders, consti-
pation, over fatigue, nerve strain (particularly of the
eyes). The tendency to headache may, in many cases, be
overcome by correcting these irregularities.
The direct effect of headache pain is usually from con-
gestion of blood in the head, which causes pressure on the
nerves. Or it may be that tension, over-fatigue, etc., af-
fects the nerves directly.
Treatment. Try to remove the congestion by drawing
the blood away from the head by such effective methods
as : hot mustard foot bath, mustard paste between the shoul-
ders just below the neck, heat or cold over the seat of the
trouble, hot water bottle to the feet or to the back of the
neck. Have patient lying down to rest the nerves, with
the head high and the eyes protected from the light.
Constipation is at all times a serious menace to a
healthy condition of the body. When this exists the
residue or waste of one part of the body is not expelled in
the normal way by the muscular action of the colon but
is retained in the system longer than usual and from this
there is an absorption back into the tissues with the result
that the patient has the symptoms resembling those of an
enervating, slow poison, with consequent lack of energy,
heaviness and irritability, besides the distress of an accu-
mulation of gas in the abdomen.
134 PRACTICAL HOME NURSING
In time of illness there is a natural tendency to consti-
pation due to the lack of general exercise and the conse-
quent inactivity of the muscles of the intestines ; and also
because the diet at such times consists of more condensed
food, most of which is absorbed without leaving sufficient
waste to stimulate the muscles of the colon and keep them
Treatment. The influence of the habit of evacuating
the bowels at a regular hour each day has the most per-
manent effect in overcoming constipation, and even in time
of illness this has proved an efficient help towards coun-
teracting this tendency.
Exercise the muscles of the legs which directly affect
the intestinal muscles. The simplest way of doing this is
to walk (even walking up and down stairs). If exercise
can be combined with pleasure, so much the better.
Rub the muscles of the colon in the natural direction up
the right side, across the top and down the left side.
Allow the patient to drink freely of water because
fluids, being absorbed in the large intestines, stimulate the
muscles there. Also give fruit and green vegetables for
the sake of the mineral salts contained in them, which
have the same effect. The fiber of the vegetables, well
cooked and unstrained, as well as coarse grained cereals
and breads are valuable in the diet as all of these leave
more bulk or waste which is not absorbed, and their pres-
ence in the colon stimulates the muscles to act and expel
the feces from the rectum.
An enema or laxative is frequently given to overcome
this condition when other efforts fail.
Diarrhoea is caused by increased intestinal peristalsis or
increased intestinal secretion. The muscles of the intes-
tines are over-stimulated, irritated or too much relaxed.
This may be caused by undigested food, any irritating
substance or from nervous conditions.
MINOR ILLNESSES AND DISORDERS 135
Treatment. Observe the movements: whether they
contain undigested food, mucus, etc., also whether there
are any traces of blood. The safest and quickest treat-
ment is to give a large dose of castor oil to clear away the
irritating cause. Keep the patient quiet, warm, if possible
in bed, with hot water bottles at the abdomen and at the
feet. For diet, give food that will be more easily di-
gested in the stomach such as white of egg, scraped beef,
Hour gruels, barley or rice water, toast. This diet gives
very little effort to the intestines and enables them to rest.
Give no fats and restrict fluids and provide a very simple
diet afterwards. When there is a tendency to this condi-
tion, special care should be taken in regard to the regular
diet in order not to overstimulate or exercise the muscles
of the intestines. A change of air and building up of the
general system is usually advised to help overcome this
Fever may be caused by a variety of conditions or may
be the first symptom of a serious disorder.
Treatment. In any case of fever, it is perfectly safe
to bathe the patient with water, tepid or cold, using a
great deal of water and allowing it to evaporate. Rub the
body at the same time in order to bring the blood from
the heated parts to the surface to cool it in turn. Keep a
cold cloth or an ice bag on the head; have light covering
over the patient and see that the room is cool. Give either
an enema or a laxative to produce an effective action of the
bowels, plenty of fluid to drink is required and a very light
diet, usually fluid or semi-solid. Watch the temperature
closely and when it falls remove cold from the head.
CRAMPS OR COLIC
Cramps or colic from gas in the abdomen are usually
relieved by heat applied to the abdomen — either by hot
water bags or by hot fomentations (page 107) or by im-
136 PRACTICAL HOME NURSING
mersing the body in hot water up to the waist line. Give
an enema which, in this case could be made effective by a
combination of 1 part of turpentine and 2 parts of sweet
oil. A rectal tube inserted in the rectum and left there
makes a passage through which gas may escape more easily.
Ginger tea, essence of peppermint in hot water, or soda and
hot water taken by mouth, sometimes give relief.
Earache may be caused by some indirect trouble with
the teeth, or from cold, or by a purely local disease of the
Treatment. Have the patient keep the head raised on
a pillow and lay the affected ear on a hot water bag (not
too full). Lacking that, apply hot cloths or even a poul-
tice over the outside ear. If persistent an earache may be
relieved by careful syringing with hot water (108°), for
method see page 102. An earache should always be re-
ported to a physician even if it has been relieved. Care-
fully note any sign of discharge.
Treatment. Keep the head high on a pillow, and some
temporary relief may be obtained by applying a swab of
cotton, soaked in spirits of camphor or some form of alco-
hol, directly on the gum around the tooth. This will prob-
ably relieve the pain. A dental poultice can be used in
the same way after soaking it a minute in warm water.
Another remedy is to paint the gum with iodine. Oil of
cloves may be dropped in the cavity of the tooth, or a small
piece of cotton soaked in it inserted in the cavity. This
at best can only afford temporary relief and as soon as
possible the affected tooth should be examined by a dentist.
MINOR ILLNESSES AND DISORDERS 137
Neuralgia. (Nerve pain) usually indicates a rather
lowered general vitality of the patient and is best over-
come permanently by improving the general conditions,
securing good nourishing food, plenty of fresh air and
sleep, and if possible a change of air. Look also for any
local cause of the trouble, such as toothache or pressure on
Treatment. For immediate relief, heat should be ap-
plied to the part where the pain is felt, also keep it as
quiet as possible. Menthol pencils or menthol fluids ap-
plied directly over the affected parts usually give relief.
VOMITING — NAUSEA
Vomiting may be caused by irritated nerves of the
stomach, too great acidity or by bile or unsuitable food.
Observe the vomited substance and if necessary pre-
serve for the examination of the physician.
Treatment. Lay patient down to relieve pressure on
the nerves that lie back of the stomach, provide fresh air,
apply a mustard paste over the pit of the stomach and give
hot water in sips with a little soda in it (1 teaspoonful to
a half glass) or pieces of ice to be swallowed whole, darken
the room and try to induce sleep. If persistent give a
glass full of water as hot as can be swallowed.
INSOMNIA OR SLEEPLESSNESS
Insomnia has many causes — too great activity of the
brain, reflex action from over fatigue, nervousness, worry
or from habit.
Treatment. It is important to draw the blood away
from the head by means of a warm bath, heat applied to
the extremities either by mustard foot bath or a hot water
bottle ; for the same reason some easily digested food, or a
hot drink may be taken before going to bed ; this tends to
draw the blood to the stomach during its digestion and
thus relieves the amount in the head ; mustard plaster at
PRACTICAL HOME NURSING
the back of the neck or over the stomach causes a sensa-
tion of sleepiness, gentle rubbing is also soothing, avoid
stimulants, such as tea or coffee late in the day, divert the
mird from the subject which is keeping it active by trying
to induce the patient to think of something else, or to do
some active work, or take a walk before going to bed. If
this condition becomes habitual a total change of air and
scene will be the most effective means to help overcome the
A chill may be the initial symptom of disease or the re-
sult of nervous reaction from severe pain or nervousness.
The blood vessels of the skin contract and thus a
greater amount of blood is sent to the interior of the body
which causes sensation of cold on the surface with shiver-
ing of the body and chattering of _the teeth more or less
violent according to the intensity of the chill.
Treatment. Lay the patient down, apply hot water
bags, wrap up in blankets and give hot drinks. Take the
temperature after the chill, and again in an hour: a high
fever rarely follows in a case of chill arising from nervous-
ness but with those from other causes the temperature will
be very high and this should be watched carefully.
Hives is an eruption that comes on the body in the
form of pale red circles from % to 1 inch in diameter,
which are very itchy. The cause may be from indigestion,
constipation or from eating certain foods.
Treatment. Give a laxative, preferably magnesia in
this case, and for the relief of the itchiness apply car-
bolized vaseline or camphor ice or menthol. Give water
freely and a very light diet for a few days.
CATARRHAL COLD IN THE HEAD
This is an inflammation of the mucous membrance of
the nose and the throat and often of the eyes as well with
MINOR ILLNESSES AND DISORDERS 139
a very free discbarge of mucous which may extend to the
trachea or even bronchial tubes.
Treatment. Give the patient a warm bath and a laxa-
tive and keep in bed for a few days. Some relief is ob-
tained by inhaling steam from a solution of benzoin (1
tsp. to a pt. of water — or the same amount of pulverized
camphor) and for this treatment a paper cone can be made
of newspaper or brown paper to extend from the kettle to
the patient. Gargling the throat with an astringent; such
as lemon juice, glycerine, water and soda or very hot saline
solution may provide relief.
Give fluid drinks such as hot lemonade and plenty of
water. To allay irritation of the surface of the throat,
which frequently causes coughing, give the white of egg
with a little lemon juice in it. Apply a mustard paste, or
a flaxseed poultice over the chest and throat or rub on
camphorated oil, or turpentine and oil in equal parts.
(This treatment must be stopped before the skin is too
much irritated.) Give a light but nourishing diet. Care
is needed to build up the system afterwards to prevent a
repetition of the same condition.
It is always important to take precautions in regard to
a sore throat as it may indicate so many serious conditions;
look into the throat and see if there are evidences of
spots or membrane on it or if it is very red. It is safer to
isolate any one with a sore throat until sure that it is not
of an infectious nature.
Treatment. For immediate relief use a very hot
saline solution gargle, or an irrigation of the same (for
method see page 103) or an astringent gargle or spray
might be substituted. Either hot applications (poultices
or fomentations) or ice cold applications may be used on
the outside of the throat and in many cases afford speedy
relief. Give a laxative and watch the temperature closely
and allow very light diet.
Emergency treatment is chiefly given :
1. To prevent further injury to the affected part by
handling the patient carefully.
2. To save undue effort of the heart which suffers from
extra strain on account of the general shock of the injury.
3. To give all the comfort and ease and relief possible
to the patient.
RULES FOR EMERGENCIES
1. Keep calm.
2. Have the patient lie down, admit fresh air, loosen
clothing, and make the patient comfortable until the physi-
3. Give simple stimulants, such as a drink of water, a
cool breeze supplied by fanning, or external heat.
4. When sending a message to a physician, state the
nature of the case clearly.
In connection with all injuries there is a more or less
serious depression of the nervous system which frequently
affects such vital parts as the heart. This condition is
spoken of as shock, sometimes prostration, and may be
recognized by extreme pallor, feeling of cold, clammy skin,
feeble pulse and shallow breathing.
Treatment. Eemove the cause if apparent (such as
hemorrhage) ; heat the body by covering the patient, ap-
plying hot water bags and giving hot drinks — coffee, tea,
etc. Lay patient on the back with the head low. Admit
fresh air and loosen any constricting clothing at the neck.
Stimulate by inhaling smelling salts or ammonia, or by
giving aromatic spirits of ammonia, half a teaspoonful in
a little water.
Cause. Loss of blood to the brain due to some dis-
turbance in the circulation.
Symptoms. White face, feeble pulse, shallow breath-
ing, giddiness to unconsciousness.
Treatment. Send blood to the brain by placing the
patient in a lying-down position, and if possible with the
head lower than the heart or if unable to do this, bend
the head down over the knees. Provide free circulation of
fresh air for the effect of oxygen on the blood — make a
crowd stand aside — loosen any tight clothing — espe-
cially at the neck. Smelling salts may be used for inhal-
ing — holding it so as not to spill the fluid. Ammonia
or aromatic spirits of ammonia can be sprinkled on a hand-
kerchief and held to the nose likewise. When the patient
becomes conscious, a stimulant may be given of aromatic
spirits of ammonia (half a teaspoonful to 1 ounce of
water), or alcohol (such as whiskey: 1-2 tablespoonfuls to
% as much hot water or a little sherry). For some time
afterwards, keep the patient lying down, quiet and warm.
Cause. Pressure on some part of the brain caused
Symptoms. Unconsciousness, flushed face, difficult
noisy breathing, and one or both pupils of the eyes may be
dilated. This condition is followed by paralysis of the
muscles, either slight or severe.
Treatment. Elevate the head and chest, holding the
head steady while doing this ; loosen clothing at the neck ;
apply ice or cold to the head and warmth to the extremi-
ties. Do not move the patient unless absolutely necessary
and do not give alcoholic stimulants in this case.
PRACTICAL HOME NURSING
What is the cause of fainting I
What would you do for the patient ?
How does position affect this condition ?
Mention stimulants that could be used for inhaling.
What is the cause of apoplexy (
How treat the patient — why elevate the head ?
What condition follows an attack of apoplexy ?
A fracture is the breaking of a bone. The chief kinds
are Simple and Compound.
A simple fracture is where the bone is broken and
no wound leads to the surface.
A compound fracture is where the bone is broken and
the air penetrates to the broken bone. The latter is always
serious from the danger of infection being carried into the
bone and tissues.
The emergency treatment of fractures is largely to pre-
vent a simple one from becoming compound, by careful
handling of the part.
Symptoms. Loss of power of the part, pain (from
injury to the nerve), swelling (from fluid in the tissues),
and discoloration (from the escape of blood from the
small blood vessels).
Appliances for the treatment of fractures are splints and
bandages. For the former can be utilized a flat piece of
wood, a walking stick or umbrella, a folded newspaper or
cardboard, in fact anything that is firm and long enough
to reach beyond the joints above and below the break.
These should be padded with whatever is available. For
bandages — handkerchiefs, ties, torn up clothing or regu-
lar bandages (if available) can be used.
Treatment. For a simple fracture. Keep the in-
jured part quiet and slightly elevated with a support un-
derneath. Apply cold over the part and lay the patient
down on account of shock.
For a compound fracture, the same treatment applies
except that in addition it is necessary to cleanse the wound
and to place a sterile dressing over it. (See page 51.)
For simple fracture of the lower extremity. Place
the patient on the back and put a splint or support under-
neath the injured leg, extending beyond the adjacent
joints and tie this on with a bandage. Support may also
be provided on either side of the fracture. Lacking
splints, tie the legs together at points beyond the joints
adjacent to the break if it is necessary to move the patient.
Always apply cold over the part if practical in order to
reduce the tendency to inflammation.
For fracture of the arm: Place the injured part on a
pillow and apply cold over the surface. If it is
necessary to move the patient, bandage on a splint under-
neath the fractured part, extending above and below the
adjacent joints. Adjust a sling to give additional support
and keep the arm quiet. If the injury is in the forearm,
the elbow is encased in the sling, while if in the upper
arm, the sling extends only to the elbow and does not
For a fractured collar bone: Place a pad under the
arm on the injured side — flex the arm and have the
fingers nearly touching the opposite collar bone, and band-
age the elbow close to the body to keep the shoulder
For broken ribs: Place a bandage, such as a folded
towel, closely around the chest, and pin firmly to keep the
muscles between the ribs quiet.
A sprain is the tearing or injuring of the ligaments
around a joint and this becomes swollen and discolored
144 PRACTICAL HOME NURSING
due to the hemorrhage of the smaller blood vessels into the
deeper tissues, and any movement of the muscles pains
Treatment of a sprained ankle. Slightly elevate the
ankle and support it comfortably; apply either heat or
cold continuously over the joint for 1 or 2 hours, then
bandage firmly to support it and to keep the muscles quiet
around the joint.
If the ankle is sprained while out of doors and the
patient is obliged to walk home, it would be best to keep
the shoe on and bandage tightly outside of that with what-
ever is available (a handkerchief or tie), giving the above
treatment as soon as possible. A sprained wrist or knee
would be treated in same way.
A strain is an injury to or a twisting of a muscle.
Symptoms: Sharp pain in the muscles when moving
them, probably swelling of the part.
Treatment : Place the patient in the most comfortable
position, with a support, such as a pillow, under the in-
jured part, and apply heat (hot water bottles or hot fomen-
tations — see page 106) over the strained muscle.
A dislocation is where the ball at the end of a bone is
out of its socket, causing deformity and swelling.
Treatment for dislocated finger. Apply cold over
the joint and if a physician is not available an attempt
can be made to replace the dislocation by pulling the finger
hard and straight out beyond the ridge of the socket, letting
it snap back into place. If this is accomplished, bandage it
securely and keep cold over the joint for some time.
For a dislocation of the jaw, under like circumstances,
wrap both thumbs in cloth — then place them in the pa-
tient's mouth, resting on the lower teeth while the fingers
grasp the jaw outside. Make pressure downward and
backward, quickly letting go as it slides into the socket.
Bandage the jaw to keep it in place.
For dislocations of other joints, support the part and
keep cold applied until a surgeon arrives. Do not attempt
What is a fracture ?
State difference between a simple and compound fracture.
How treat simple fracture until the surgeon's arrival.
What can be done to prevent a simple fracture from becom-
ing compound ?
Mention important points in adjusting a sling.
How is new bone formed ?
What is a sprain ?
How could you relieve the pain in a sprained ankle ?
What is a strain — how relieve ?
Cause : The escape of blood from a blood vessel.
Symptoms: Blood from the wound, pallor, feeble
pulse, and, if severe, general prostration.
Treatment: Elevate the part, lay patient down,
and apply pressure on the main artery between
the wound and the heart. This can be done either with
the fingers — a ligature — or a tight bandage which can
hold a pad or some other pressure over the artery. A
tourniquet may be used if necessary (see page 179), but
this should not be left on longer than half an hour and
loosened very gradually. In hemorrhage from veins —
pressure is made below the wound. In hemorrhage from
capillaries — pressure is made over the wound. Give
no alcoholic stimulants in cases of hemorrhage.
PRACTICAL HOME NURSING
MAIN ARTERIES THAT MAY BE PRESSED
TO CONTROL HEMORRHAGE
For internal hemorrhage — Carotid artery, in the
neck, on either side, at a point on a level with the chin.
For external hemorrhage — Carotid artery, in front
of the ear. Temporal artery, over the temporal bone.
Upper Arm — Subclavian artery, under the clavicle
bone, pressing from above down. Brachial artery, on the
inner side of the upper arm.
Lower Arm — Brachial artery or applying pressure
by placing a pad in the bend of the elbow and bandaging
the lower and upper arm together.
Thigh — Femoral artery, in the groin midway be-
tween the hip and the center of the body, or along the
inner side of the upper leg.
Lower leg — Popliteal artery, under the knee, apply-
ing pressure with a pad held in place by bending the leg
back and bandaging to the thigh.
Cause : Escape of blood from a blood vessel.
Symptoms : Low temperature, weak, rapid pulse, pal-
lor, thirst and prostration.
Treatment: Lay patient down, raise the affected
part if practical. Keep absolutely quiet, with ice on the
part. Give no alcoholic stimulant and treat prostration
by external heat.
Treatment: Raise the head and, if easier to keep
patient quiet, lay lier down with the head raised on a pillow
and turned to one side so that the blood may trickle easily
into a basin. Apply ice over the nose. Pressure can be
made on the artery leading to the nose by placing a pad
under the upper lip, close to the outer angle of the nostril.
If necessary, use an astringent; for this, vinegar, diluted
with equal parts of water, may be sprayed on or brushed
over the surface inside of the nostril or a piece of cotton
saturated with alum placed inside the nostril.
HEMORRHAGE OF THE THROAT
Symptoms : Bright red blood from the mouth.
Treatment: Keep the head raised and supported to
keep it quiet, with cold on the outside of the throat. An
astringent spray may be used.
HEMORRHAGE OF THE LUNGS
Symptoms: Blood filled with air bubbles, from the
mouth (this shows the interchange of air and blood in
the lungs). This hemorrhage usually follows the effort
Treatment : Keep patient lying down and quiet, with
head and chest slightly raised. Ice can be applied to
the throat and chest and heat to the body. Small pieces of
cracked ice given by mouth relieve thirst.
HEMORRHAGE OF THE STOMACH
Symptoms : Blood vomited, dark in color, mixed with
food and juices (often resembles coffee grounds).
Treatment: Have patient lying down quiet, with
ice on the pit of the stomach.
HEMORRHAGE OF INTESTINES
Symptoms: Blood from the rectum resembling that
of a hemorrhage of the stomach.
148 PRACTICAL HOME NURSING
Treatment : Keep patient quiet and lying down with
the foot of the bed raised, and ice on the abdomen.
HEMORRHAGE OF THE UTERUS
Symptoms : Blood from the vagina.
Treatment Keep patient lying down, move for no
reason whatever, raise the foot of the bed. Tie the knees
together to prevent the patient from moving the legs.
What is hemorrhage ?
What are the means used to control hemorrhage ?
How may pressure be applied ?
What quality in blood assists in stopping hemorrhage?
How would you control a hemorrhage from the upper arm ?
How distinguish between bleeding from the lungs and the
What is the difference in the treatment ?
How arrest hemorrhage from the nose ?
What could be done to check a hemorrhage from the
BURNS AND SCALDS
A burn is an injury to tissue caused by dry heat, while
a scald is a similar injury caused by moist heat.
1. The effect of a burn may be a mere reddening of the
2. The formation of blisters on it.
3. The deeper tissues may be involved.
If clothing adheres to a burned surface, it must be
most carefully removed to prevent further injury. Cut
it away from around the part and saturate with oil or
water any clothing that is directly over the burn, as this
makes its removal easier.
Methods of Treatment : Cover the burn to exclude
the air, and thus ease the pain.
1. Place the burned part in a solution of water and bi-
carbonate of soda (baking soda), 1 oz. to a pint of water;
or, if there is no soda available, use water alone at the
temperature of the body (98°). This excludes the air
and gives temporary relief.
2. Place a wet dressing of above bicarbonate solution
over the injured part and keep it wet.
3. A lotion of sweet oil and lime water (equal parts
shaken together) may be used as a dressing — or carron
oil, which is linseed oil and lime vater in equal parts.
Vaseline and goda combined or boracic ointment are like-
wise valuable. Picric acid gauze can be obtained and
placed directly over the burn. Another treatment, largely
used at the present time, is the application of a form of
parafin which is placed over the burn, where it hardens
and forms a protective covering. Always bandage the
dressing on a burn without any pressure, very lightly
and keep the part supported comfortably.
Patients suffer from shock very much in case of burns
for which treatment may be given as described (see page
Sunburn is really a mild burn.
Treatment: Use for relief a weak solution of baking
soda and water, or apply oil and soda, or white of egg
spread over the burn, or talcum powder, and keep it cov-
If clothes catch on fire (self), try to keep your presence
of mind. Lie down and press the burning parts to the
floor to prevent a draught and thus put out the fire; or
if there is a woolen article or wet cloth handy, pull this
closely around yourself, but do not run for a wrap as
this increases the danger of flame.
If the clothes of another person catch fire, do the same
thing to them, and if possible to secure a rug or blanket
or a wet sheet, wrap it around them from the head down
PRACTICAL HOME NURSING
to prevent the fire from reaching the hair and face and
the inhaling of the flame.
OVERCOME BY SMOKE
If a patient is overcome by smoke inhaled, get them at
once into the fresh air, make a crowd (if any) stand back,
give artificial respiration and stimulants.
When exposed to severe cold, such parts of the body as
the ears, nose, feet and fingers are apt to freeze. The
frozen part loses sensation, becomes waxy white and later
is congested and a dark blue color.
Treatment: Do not take patient into a warm
room but keep in cool place. Rub the frostbitten part
gently with a cold cloth or with snow, and later with the
hand or a towel. Or when possible, as in the case of a
frozen foot or hand, place it in cold water and rub while
there to restore the circulation safely. When circulation
is fully restored, have the patient still kept in a cool room
for some time as the return to heat must be very gradual.
After this, a soothing ointment as for a burn may be used
on the surface.
What aid could you give to a person whose clothes were
What could you do if your own clothes were on fire ?
How remove clothing from a burned surface ?
What is a burn ?
What is the first thing to do to relieve the pain of a burn ?
What simple dressings may be applied ?
What is the great danger attending a severe burn ?
Schafer method : Lay the patient on chest, with head
turned to one side in order to keep the nose and mouth
off the ground. Have arms extended over the head.
Then kneel alongside or astride of patient facing the head
and, placing both your hands with palms down on the
lower ribs, one on either side of the spine, press steadily
downward and forward, bringing the weight of your body
to bear on your hands while you swing your body forward,
thus pressing the air out of the patient's lungs. This pro-
duces expiration. Draw back your body somewhat more
rapidly and relax the pressure without removing your
hands. This produces inspiration. Continue these
movements alternately until respiration is restored or a
doctor pronounces life to be extinct.
As quickly as possible loosen the patient's clothing and
clear the mouth and throat by wiping it out with a hand-
kerchief wound around your finger. Place patient face
downward with a pad below the chest, or, in place of a pad,
press from underneath with your hands on the pit of the
stomach; this movement is made to help free the passage
from water. Then give artificial respiration as described
above until breathing is restored.
Surround the patient with heat as soon as it can be
obtained and also give stimulation.
Give fresh air in abundance. Keep the patient lying
down. Apply external heat and stimulation and, if neces-
sary, artificial respiration. For some days afterwards, the
patient should take a quantity of fluid to help eliminate
If necessary to remove patient from contact with a live
wire protect your hands with something which will resist
the current, such as rubber, dry silk, dry cloth, dry wood or
152 PRACTICAL HOME NURSING
straw, or newspaper, or else drag the patient away with a
rope or push with a stick.
Treatment for insensibility: Lay patient down,
loosen clothing, give fresh air, keep slapping the face and
chest with wet cloths and give artificial respiration.
After consciousness is restored, treat the burns, if there
are any. The same treatment applies in shock from light-
SUN STROKE OR HEAT STROKE
Cause : Exposure to excessive heat or to the sun's rays.
Symptoms: High temperature, flushed face, faint-
ness, difficulty in breathing.
Treatment : Move patient to a cool place, loosen or
remove most of clothing, fan vigorously, apply cold to the
head and body. Give no alcoholic stimulants, but when
the patient is able to swallow give cold water.
HEAT EXHAUSTION OR COLLAPSE FROM
Symptoms: Weakness (without unconsciousness),
pulse weak and rapid, breathing shallow.
Treatment: Put patient in a cool place, give stimu-
lants sucb as tea, coffee, aromatic spirits of ammonia, and
apply heat to the extremities.
Cause : Undigested food, cold, or from eating heartily
Symptoms: Acute pain in stomach or abdomen, or
Treatment: Give a strong emetic of mustard, or salt
and water, and when the stomach is quieted, give a dose
of castor oil. Secure a free action from the bowels by an
enema at once. Give hot water with a little soda in it
to counteract the acidity of the stomach. Rest, warmth
are helpful and the diet, following this, should consist of
the simplest sort of food, such as beef tea, gruels, etc.
What is the first thing to do in case of drowning?
Describe Scbafer method of artificial respiration.
State treatment for patient overcome by gas or smoke.
Give symptoms of sunstroke.
What should be done immediately ?
Give treatment for patient suffering from heat exhaustion.
What symptoms would there be in evidence with acute
How relieve this condition ?
FOREIGN BODY IN THE NOSE
Make pressure on the opposite nostril and have patient
take a deep breath through the mouth and then close it.
Thus the air may force the obstacle out. Or, while press-
ing on the opposite nostril, blow the nose hard or induce
sneezing by tickling the inside of the nostril, or having a
little pepper in the air.
FOREIGN BODY IN THE EAR
If it is a hard substance, hold the head down on the
affected side to prevent its going farther in, and unless it
falls out easily, seek medical aid, as it is never safe to put
an instrument in the ear.
If there is an insect in the ear, pull the ear upward
and backward and drop in warm oil, or syringe it with
warm water, being careful not to close the opening into
the ear with the end of the syringe.
FOREIGN BODY IN THE EYE
Pull down lower lid and if the substance can be seen
remove it with the pointed corner of a handkerchief.
When it is beneath the upper lid, draw the upper lid out
and push the lower lid up under it. The substance may
then attach itself to the eyelashes on the lower lid. When
154 PRACTICAL HOME NURSING
any foreign body is firmly attached in the eyeball, place
wet gauze or a wet handkerchief loosely over the eye and
hold it on with a very light bandage until patient can be
taken to a physician.
It is always safe and generally successful to try to
remove a foreign body by washing the eye out carefully
(using weak salt and water, boracic acid solution or plain
water) and as the fluid goes over the surface, hold the lid
out from the eye and direct the patient to move the eyeball
up and down.
FOREIGN BODY IN THE THROAT
Insert your finger along the inside of the cheek as far
back as possible, then make an outward motion with the
finger to dislodge the obstacle. Bend patient's head for-
ward and slap between the shoulders hard to force a cough.
In the case of a very small child hold up by feet with head
down and slap between the shoulders.
FOREIGN BODY SWALLOWED
Do not cause vomiting by an emetic or give a laxative,
but give starchy food (such as potatoes, bread, oatmeal,
cornmeal mush) in which the substance will more likely
pass safely through and out of the body. Observe the
stools until the object is passed.
WASP STINGS AND INSECT BITES
Apply a strong alkali to counteract the strong acid of
the sting, such as ammonia, soda, lime water, or menthol,
if indoors. If out of doors, apply mud as this contains a
RELIEF FROM FLIES AND MOSQUITOES
Pour into an atomizer half a teaspoonful of lavender
oil. Add to this as much alcohol as will make a saturated
solution. Use as a spray. Sweet clover hung about the
room will banish flies and mosquitoes. The drier the
clover becomes, the more effectual it is.
If a foreign body is swallowed what should be done about
What would you do if lime was in the eye ?
Xame fluids that could be used to wash out the eyes.
How would you treat if a foreign body was under the
upper lid ?
If firm in the eyeball what could be done ?
How try to remove an insect from the ear?
Would you make any effort to remove any hard substance %
How relieve earache %
Cause: Uncontrolled nerves often due to overfatigue,
or nerve strain, or habitual lack of self-control.
Symptoms: In appearance, the symptoms are rather
negative. The body is warm, the color and pulse normal.
The patient acts in an uncontrolled way, sometimes grind-
ing the teeth, or thrashing around, and alternately weeping
Treatment: Leave unnoticed as much as possible in
order that the patient may get control of herself. Speak
sharply to attract attention and divert the mind.
Sprinkle cold water or apply a cold sponge to the f^ce.
A warm bath often gives immediate relief in such cases,
and complete rest is required afterwards as the patient has
had a certain amount of strain, both physical and nervous.
Cause : A disease of the nervous system.
Symptoms: Usually a shrill cry accompanied by con-
vulsions and unconsciousness, throwing the limbs about,
156 PRACTICAL HOME NURSING
while the whole body twitches violently. In a few mo-
ments the patient recovers consciousness but is drowsy and
Treatment: Prevent patient from injuring himself
when twitching. Place a hard substance, such as a pen-
cil or even a rolled up handkerchief, between the back
teeth to prevent biting the tongue, loosen the clothing
around the neck, place a pad or pillow beneath the head
and remove any obstacles which the patient might knock
What is the usual cause of hysteria ?
How could you help a patient to regain control ?
What after treatment is necessary ?
Describe an attack of epilepsy.
What special care must be taken in treating such a condi-
In case of poisoning send for a physician at once, stating
the case, and if possible, the name of the poison. Poisons
either irritate or deaden sensibilities.
Irritant poisons: Irritant poisoning is caused by
strong acids, alkalies, or chemicals.
Symptoms : Severe pain in the stomach and abdomen,
vomiting, diarrhoea and extreme prostration — the severity
of the prostration depending upon the poison.
Treatment. To neutralize the poison give the anti-
dote if known. If the definite antidote is not known, it
is well to remember that if an acid has been taken to give
an alkali and if a strong alkali to give an acid. See page
If the poison has been taken by mouth, give an emetic
(except where the poison has burned the lining of the
mouth) of salt and water, 1 tbsp. to a glass; and persist
in causing free vomiting. Give something to soothe the
surface, such as white of egg or milk or cereal gruel.
When the mouth has been burned give the soothing
drink instead of the emetic. Treat the shock by inhaling
ammonia or giving coffee, tea, or alcohol (by enema, if
necessary), and by external heat.
Narcotic poisoning. These dull the sensibilities and
are usually caused by some form of opium.
Opium poisoning. Symptoms: Drowsiness to un-
consciousness ; contracted or very small pupils of the eyes
(pin points) ; very slow breathing.
Treatment : Is taken by mouth, wash out the stomach
freely with emetic. It is more difficult in this case be-
cause the patient only wants to be let alone. Use irritant
emetics, such as mustard and water — 2 tsps. to a glass,
or salt in the same proportion. Keep patient awake by
walking about or by any practical means — such as flicking
with wet towel particularly on the chest and face. Give
stimulation by large quantities of black coffee or tea.
Never give alcoholic stimulation in these cases as this
tends to produce stupor. Apply artificial respiration, if
Ptomaine poisoning. The cause is poisoning by food.
Symptoms: Great prostration, severe pain in the ab-
domen, vomiting, diarrhoea, very weak pulse, cold, clammy
Treatment. Wash out the stomach by salt and water
emetic, followed by a dose of castor oil. Later, saline irri-
gations by rectum are given. Stimulate by external heat,
hot water bottles and blankets.
State the most important thing to do in case of poison
being taken by mouth.
What is an antidote ?
What emetics could be used ?
158 PRACTICAL HOME NURSING
Give symptoms of irritant poisoning.
Give treatment for such a ease.
Give symptoms of opium poisoning.
Give treatment. Why has the patient to be kept awake ?
What is the most effective stimulant in this case ?
What is meant by ptomaine poisoning?
Give symptoms. How treated ?
How treat the shock caused by poisoning?
CONVULSIONS (OF CHILDREN)
A convulsion is a spasm or an involuntary contraction
of the muscles of the body caused often by indigestion, high
fever, or it may be the initiation of some disease.
Symptoms: Muscles contracted, face almost blue, in-
sensibility, frothing at the mouth.
Treatment: Place cold on the head.* Put the child
in a hot bath registering 105° by a thermometer, but lack-
ing the latter, test the heat by placing your elbow in the
water (in the excitement of such a time, children have
been burned by too hot water). Mustard may be added to
the bath — 1 tablespoonful to a gallon of water. Keep in
the bath 5 or 10 minutes or until muscles relax, then wrap
in a warm blanket and keep cold at the head, and let the
child sleep. Later give an enema and a dose of castor oil.
Lacking the opportunity to give a bath, place cloths
wrung out of hot water and mustard around the body, or
put the feet in a basin of mustard and water. The mus-
tard used should first be dissolved in cold water or put in a
cheesecloth bag and squeezed into the water. Keep close
track of the temperature after a convulsion and give noth-
ing but water temporarily, followed by a very light diet
for the next 24 hours.
* Note: If the child is old enough to have teeth place
something between them to prevent biting the tongue.
(The rolled up corner of a handkerchief answers this pur-
Croup is a contraction of the muscles at the entrance
to the trachea from the throat.
Symptoms: The chief symptoms are a noisy,
" croupy " cough, difficulty of drawing air into the wind-
pipe and straining for breath.
There are two distinct sorts of croup ; one is the ordinary
catarrhal croup and the other a membranous croup and
very serious. The initial symptom — difficulty in breath-
ing — is the same in both. Fortunately the latter is com-
paratively rare but if a child shows symptoms of croup
look in the throat immediately and see if there is any
sign of membrane forming there. If so, report it to the
physician at once.
Treatment : Give an emetic of a teaspoonful of syrup
of ipecac, a little alum on sugar, or one teaspoonful of
melted vaseline. The finger can be put down the throat
to induce vomiting. Place hot, moist cloths around the
neck and down the middle of the chest, keeping a warm
hot water bottle over them, or a flaxseed poultice can be
Hot, moist air to breathe relaxes the muscles and may be
provided by the following methods :
1. Place a screen around the crib and cover the crib and
screen with a sheet. If there is a croup kettle (this is a
kettle with a long funnel spout) use this over some heating
apparatus (alcohol or gas lamp) near the bed, being careful
to avoid the danger of fire. Let the steam escape through
the funnel under the sheet into the enclosed space.
Lacking a croup kettle, use an ordinary kettle with a
paper funnel or a child's bugle attached to the spout.
2. Take the child to the bathroom and turn on the hot
water so that the resulting steam may be breathed.
3. Or take the child to the kitchen where a temporary
bed may be made on a table or chairs near the stove, with
an umbrella and sheet over it to provide an enclosed space.
160 PRACTICAL HOME NURSING
Have the steam from the kettle directed into this space by
means of an improvised paper funnel.
A mustard foot bath is sometimes very effective.
Be careful in giving the treatments outlined above that
the child does not take cold as the effort of difficult breath-
ing causes excessive perspiration. Afterwards give a lax-
ative. The diet for the next few days should be very
What are the causes of convulsions in children ?
What are the signs ?
Describe the treatment in detail.
How prevent biting the tongue when in a convulsion if
child is old enough to have teeth ?
Why should a close watch be kept on the temperature after-
What is the first thing to do if a child develops croup ?
Is simple croup dangerous ?
What can be done to relieve the condition %
What after care is necessary ?
Bandages are used for various purposes:
To give support to an injured part.
To limit or restrict motion.
To apply pressure.
To hold dressings or splints in place.
To control swelling of a part.
They can be made of almost any material that is pliable
enough to shape to the part: muslin, gauze, stockinet,
flannel, rubber and also crepe paper. Those in most com-
mon use are the
Roller — usual lengths 5 to 7 yards, and 1 to 5 inches
wide. These should be tightly rolled up before ap-
PRACTICAL HOME NURSING
Triangular — made by folding or cutting a 40-inch
square of material diagonally and can be used either
spread out or folded into a wide or narrow band.
These are used mainly in emergency work to retain
dressings and splints.
Four-tailed — represents a roller bandage about 6 or
8 inches wide and 1 yard long, slit down from each
end to about 6 inches from the center.
FOUR-TAILED BANDAGE APPLIED
Four-tailed bandages are principally used for the head
and face, as well as for the knee and elbow. In general,
to apply a bandage of this sort, place the center over the
injured part and tie the ends securely together where they
will most firmly hold the bandage in place.
To apply a four-tailed bandage to the chin. Place
the center of the bandage over the chin itself, bringing the
two opposite lower ends to the top of the head where they
are tied, and the two opposite upper ends to the back of the
head and tied.
For the forehead, or top of the head. Place the cen-
ter of the bandage over the injury, with the two opposite,
forward ends brought to the back of the neck and tied, and
the two remaining ends brought beneath the chin and tied.
TRIANGULAR BANDAGE APPLIED
Sling for arm and hand. Hold the arm in position,
with the hand slightly raised. Slide the sling carefully
up under the arm with the point at the elbow and the bias
edge extending straight up and down on the uninjured
side and over the shoulder. Carry up the lowest point
of the bias edge over the shoulder of the injured side.
Pin both ends together to the coat at the back or else tie
in a knot at the side of the neck — a pad should be placed
under the knot. (These methods of fastening prevent
strain on the neck.) Adjust the point of the sling at the
elbow and secure with a pin. If the sling is not large
enough to reach around the back of the neck, each point
can be pinned to the coat at the shoulders. If not neces-
sary to encase the elbow, adjust the sling in the same way,
except the point which should be turned back on itself and
pinned to the under side of the sling just above the flexed
Head bandage. To protect a dressing on the head,
fold a hem two inches deep along the bias edge of the
triangle and place this around the forehead with the point
hanging down the back. Draw the rest of the triangle into
folds close to the sides of the head, cross the ends at the
back, bringing them around to the forehead where they are
tied. Bring the pointed end up and over the crossed
bandage at the back and pin securely.
Hand bandage. To retain a dressing on the hand,
place a triangular bandage spread out under the hand with
the fingers directed toward the point. Carry this point
over the back of the hand to the wrist. Draw the rest of
the bandage into folds at either side and cross it so that
the ends can be tied around the wrist. Pin the point down
Foot bandage. For dressings on the foot, use the same
method as for hands, fastening at the ankle instead of at
164 PRACTICAL HOME NURSING
,H — ' n
* \ ' s \
Tndngulor Bandage v .
A triangle folded into bands can also be used for the
eye, ear and jaw, and over any joint.
These are the most important and are used to fix and
retain dressings and splints, to prevent and control swell-
ing, and to prevent undue pressure on any part.
Suggestions for efficiency in roller bandaging.
Keep the bandage well rolled up with the roll upwards.
Leave an even space between each turn of the ban-
dage — usually from % to V 3 the width of the
bandage. The evenness of these spaces allows for
the same amount of bandage on each part and helps
to equalize the pressure.
Bandage from below upwards, that is, away from the
Make the firmness suitable to the need of that par-
Prevent pressure sores by placing padding of cotton
or some soft material at points where the pressure
might be felt, that is, at the ending point of ban-
dages or at such places as the edge of the armpit,
or, in the case of triangular bandages, under the
Sling for arm.
Roller bandage for broken collar-bone.
Figure of eight bandage.
Spiral bandage is a circular turn around any part,
either straight around or slanted upward usually with an
even space between each turn.
Figure of eight is a turn of bandage slanting up and
166 PRACTICAL HOME NURSING
another turn slanting down, forming a V with spaces be-
tween each turn.
Spiral reverse is made by turning the bandage over on
itself or reversing the downward stroke to make it fit the
Spica bandage means a figure of eight bandage that con-
nects an extremity with the trunk.
ROLLER BANDAGES APPLIED
In the following diagrams each consecutive move-
ment is indicated by the numbered sentence.
Finger bandage — (Tip of finger is to be uncovered.)
Roller 1 inch wide.
1. Make a turn around the finger about half way up.
2. Carry bandage down and make a turn around the
finger y 2 inch from the tip.
3. Make figure of eight or spiral turns until the finger
4. Then carry the bandage up over the hand and
around the wrist.
5. Down over the hand and around the base of finger.
6. Repeat up over hand and fasten around the wrist.
Finger bandage — (Tip of finger to be covered.)
Roller 1 inch wide.
1. From the base of the finger take one fold down and
over the tip.
2. Return to same point underneath finger.
3. Repeat twice, making the fold extend wider each
time at the tip.
4. Then make one fold around, half an inch from the
5. Continue to bandage the finger as described above.
168 PRACTICAL HOME NURSING
Spica for the thumb —
Roller 1 inch wide.
1. Make a turn around the wrist.
2. Carry bandage down to the tip of the thumb and
3. Bring it up the thumb with spiral or figure of eight
turns to half way above the first joint.
4. Then carry the upward turn over the hand and
around the wrist.
5. Down the hand and around the thumb, making a
figure of eight.
6. Continue these turns until the joint is covered and
fasten around the wrist.
Figure of eight bandage for knee or elbow — (To
allow for easy movement of the joint.)
Roller 2 to 2% inches wide.
1. Take bandage around the center of the elbow joint.
2. Then carry the bandage around from above with
the lower edge of the bandage to the center of the
3. Then from below take it in the same way with the
upper edge of the bandage to the center of elbow.
4. Repeat this until joint is covered, leaving a little
space between each layer. (Usually there are 5
turns in all for the elbow and 7 or 9 for the knee. )
Bandage for hand and arm —
Roller 2 to 2% inches wide.
1. Make a turn around the wrist to secure it.
2. Carry the bandage down back of hand to joint of
3. Then around the hand.
4. Carry bandage up back of hand to wrist, making a
figure of eight turn.
5. Repeat these turns until the hand is covered.
6. Make two spiral turns around wrist, leaving space
7. Then make spiral turns to the elbow.
8. Reversing this on the downward strokes.
9. Make elbow joint bandage as described above.
10. Fasten with a turn above the elbow.
170 PRACTICAL HOME NURSING
Bandage for upper arm and spica for shoulder —
Roller 2/4 to 3 inches wide.
1. Make a turn above the elbow to secure it.
2. Make spiral turns up arm until nearing shoulder
3. Reversing the downward stroke.
4. To connect it with the body carry upward stroke of
bandage across the back (for a right arm injury).
5. And under the far arm.
6. Returning it across the chest and around the arm.
7. Continue processes 4, 5, 6 until the necessary cov-
ering is provided.
Note: For a left arm injury, the first upward
stroke on the body would be across the chest, under
the far arm and over the back before completing
figure of eight turn around the arm.
Bandage for foot and leg —
Koller 2 to 2% inches wide.
1. Make a turn around the ankle to secure bandage.
2. Bring the bandage down front of foot to include the
big toe joint.
3. Carry it around the foot.
4. Then bring it up over the front of foot and around
back of the heel (leaving heel uncovered).
5. Repeat these turns until foot is covered.
6. Then make two or three circular turns around the
ankle with a space between each.
7. Make a spiral bandage up the leg to the knee.
8. Reversing or turning the downward stroke of the
bandage every time.
9. Arrange knee bandage as described before in ban-
dage for elbow or knee.
10. Make two turns around the leg above the knee to
faster the end of the bandage.
172 PRACTICAL HOME NURSING
Bandage for thigh and spica for hip —
Roller 2/4 to 3 inches wide.
1. Make two turns below the knee to secure the ban-
2. Arrange knee bandage as described before.
3. Make* two turns above the knee around the thigh.
4. Make spiral turns up the thigh, reversing each
downward stroke until near the hip joint.
5. To connect it with the body, carry upward stroke of
bandage around the waist.
6. Then bring the downward strokes around and under
the leg, forming the same figure of eight.
7. Repeat these turns until desired space is covered.
Bandage to cover the heel or foot as for sprained
Roller 2 to 2% inches wide.
1. Make two turns of bandage around the ankle to
2. Bring it from the front around and over center of
3. Then bring bandage under heel from below with
upper edge of bandage to center of heel.
4. Then, under the heel, from above to center in the
same way, overlapping each other a little at each
5. Repeat third and fourth processes, making five lay-
ers around the heel.
6. Bring bandage down front of foot to toe joint, in-
7. Then pass it under and once around the foot.
8. Make figure of eight bandage up the foot and around
back of heel (keeping it low) and down to same
point on foot.
9. Repeat until foot is covered.
10. End bandage around ankle and fasten securely.
174 PRACTICAL HOME NURSING
Bellevue walking bandage — (This holds securely
when a patient is obliged to walk with a bandage on.)
Roller 2% to 3 inches wide.
1. Make two turns around the ankle to secure the
2. Bring it around and under the instep (this prevents
it slipping up).
3. Then around ankle twice, leaving a space between.
4. Make rapid ascending turn to below the knee ( 1 or 2
5. Carry bandage around the leg below the knee.
6. Make rapid descending turn to ankle and around it.
7. Then figure of eight turns until leg is covered.
8. Take bandage around below the knee only every
second or third time that it is brought up.
9. End the bandage around the leg below the knee and
Roller bandage to cover one eye.
Roller bandage for tbe ear.
Clavicle or collar-bone bandage —
Eoller 2 to 2% inches wide.
1. Place pad in armpit (on injured side).
2. Bend the elbow, having the fingers Dearly touching
the opposite collar-bone.
3. Start the bandage from middle of back and pin se-
curely to coat.
4. Bring it over the opposite shoulder (uninjured
5. Then down to the outside of elbow and around it.
6. Then up the injured side to outside edge of shoulder.
7. Take it across the back.
8. And under the arm (uninjured side).
9. Then bring bandage across and over front of elbow
10. Continue it around to the back of the body and up to
the opposite shoulder.
11. Eepeat from process 5, making 2 turns across and 3
around the elbow.
12. End bandage in the back and fasten.
176 PRACTICAL HOME NURSING
Valpeau hammock bandage — (Particularly adapted
for use with children. )
Flannel bandage 5 inches wide, 3 yards long.
Muslin roller 2% inches wide.
1. Place a pad in the arm pit (injured side). Bend
the elbow and have fingers nearly touching opposite
2. Start at waist line in the back with the flannel band-
age and bring it up over the shoulder (uninjured
3. Carry it down in front to point of elbow (injured
side), make a loop around the elbow.
4. Bring it back up over shoulder (uninjured side)
and down to waist line.
5. Fasten there with pin and attach muslin bandage.
6. With this muslin bandage make one turn around
7. Make a second turn around the waist but this time
take it over point of elbow.
8. Bring it around the back to the front and diagonally
up over the shoulder (injured side).
9. Bring it down behind the arm, around elbow and
up in front of arm to same shoulder.
10. Then across back diagonally and around to the front
and over point of elbow.
11. Repeat processes 8, 9 and 10, until bandage reaches
Recurrent bandage for the scalp.
Roller bandage for sprained ankle.
Bandage for the eye —
Holler iy 2 to 2 inches wide.
1. Make two turns of bandage around forehead to se-
2. On second turn carry bandage behind the head, low,
almost to the neck.
3. Then pass it forward under the ear on the injured
4. Bring it up over the lower part of the eye to the fore-
5. And across the opposite side of the head and down
to the neck.
6. Then bring it forward again under the ear and up
over the eye a little higher, leaving a narrow space
7. Eepeat this until the eye is covered and end the
bandage around the forehead.
Bandage for ear —
Roller 1% to 2 inches wide.
1. Make a turn around the forehead.
2. Bring bandage down from front of forehead to low-
est point over the injured ear.
3. Continue it around the head, keeping low at back.
4. Bring it around the forehead to the center.
5. Then pass it over the ear again, a little higher, leav-
ing a narrow space each time.
6. Repeat until ear is entirely covered, and end the
bandage around the forehead.
178 PRACTICAL HOME NURSING
Recurrent bandage for the scalp —
Roller l x /2 to 2 inches wide.
1. Fasten two roller bandages together.
2. Place the center of the bandage on the forehead.
3. Carry both bandages around to the back of head.
4. Passing one underneath the other.
5. Carry the underneath one back across the middle
of the scalp, to lower edge of the forehead.
6. Carry the other bandage around the head, crossing
over the former bandage at the forehead (thus hold-
ing it firmly).
7. Continue the circle to the back of the head.
8. Carry the first bandage back over the scalp, alternat-
ing on either side of the center, at each turn.
9. Take the circular bandage across this each time to
10. Repeat this process until the entire scalp is covered.
11. Finish the bandage with a circular turn around the
(This enables very tight pressure to be made with a
bandage in case of hemorrhage.)
1. Tie a knot in a handkerchief (or some material).
2. Place this knot on the artery between the wound and
the heart (or use a pad or other hard substance in
place of the knot).
3. Tie the bandage over this pad and around the part
with a square knot.
4. Place pencil or stick through the knot.
5. Twist until hemorrhage ceases.
6. To hold the pencil firm, cross both ends of bandage.
7. Take them up and underneath the pencil.
8. Cross again on top and bring down beneath its
9. Tie a secure knot.
In removing, slip the pencil out steadily.
Untwist the bandage very slowly, holding it firmly
A tourniquet should never be used unless absolutely nec-
essary and should not be left on longer than half or three-
quarters of an hour, as it is dangerous to cut off the blood
supply to any part for too long a time.
ENTERTAINMENT OF PATIENTS
Perhaps no one responsibility in the care of the sick
calls for more judgment or understanding of human nature
than the entertaining of patients. All through average ill-
ness, the mental and nervous attitude is, to a certain exteut,
dependent upon the happiness of surroundings. There
can be no rules laid down ; each person must be considered
individually with personal likes and dislikes, but as the
need arises, patients are usually willing to become inter-
ested in something outside of themselves that will make the
time pass happily and give them employment and courage.
When very sick, physical weakness prevents effort of either
mind or body and such patients should be protected from
any well-meant efforts at diversion. But as strength in-
creases and, particularly with chronic invalids, it is often
wise to encourage them to do small things that they want
to do for themselves, thus making them feel that they are
not absolutely helpless. In fact, in caring for the really
handicapped, crippled and helpless invalids, our greatest
opportunity to alleviate this sense of helplessness lies in
the suggestion of interesting occupation, suitable to their
There is frequently a mental depression following sick-
ness and a tendency for the convalescent to hug lovingly
his or her own ailments, and keeping the hands busy is a
marvelous aid in overcoming this weakness. The needs
of convalescents differ from those of other patients to some
extent: more attention having to be paid to the condition
of mind and encouragement given to them to take up natu-
ral responsibilities gradually. On that word " gradually "
ENTERTAINMENT OF PATIENTS 181
hangs a great deal of the speed with which the usual
strength will be regained.
Convalescence really means getting back, step by step,
to normal responsibilities and the further away a patient's
mind can be directed from the idea of illness, so much
quicker will the progress be. If overtired, patients be-
come discouraged, irritable and depressed, all because they
have done more than physical strength allows. Two steps
forward and one step back is discouraging — rather one
and a half steps forward and no overtiredness.
Visitors are a great benefit when they bring in an out-
side influence that is bright and encouraging, but they
also handicap convalescents if they overtire, irritate or
are too exacting. Some visitors are comforting and re-
poseful and quietly assume the responsibility of the en-
tertaining, but it is quite the reverse when a patient has
to strive to talk to and interest a difficult person, and in-
valids should be protected from those who leave them ex-
hausted and nervous. One visitor at a time is less tax on
the nerves than two or three. The visitor should be placed
in a convenient position so that the patient may not be
obliged to turn the head to catch the sound of the voice.
Because you are in charge, you must not feel it necessary
to keep the patient amused and diverted every second.
Let her own inclinations have some weight in the matter.
It is one of the greatest mistakes to schedule every minute
Don't over-entertain. If a patient wants to rest or
do nothing, it is very trying to have some one suggest that
the best thing to do is to get up and walk, or if wanting
to read, to have gardening suggested instead. In other
words the patient's inclinations, unless unwise, should be
followed as closely as possible but when requiring guid-
ance, your resources should be sufficient to meet the need
PRACTICAL HOME NURSING
Reading aloud to patients. One of the first things
in entertaining patients is to read to them. It is some
strain on their part to listen ; this can be lessened by re-
membering to modulate the voice, and to throw it directly
towards them ; to read clearly and not too long at one time.
In reading the daily papers or magazines, make a good
choice of subjects that will interest the individual and the
same applies in discussing current events. Be interested
in the things a patient likes to talk about, and cultivate
his or her particular hobby.
Be a good listener. Nothing takes the place of this.
As illness usually prevents much contact with the world,
it is helpful if you can bring new ideas and fresh inter-
ests to the patient's mind. In fact it is a distinct duty to
go away from your patient daily for a change of thought
and scene, so that when you return the influence of this
new interest, whatever it may be, will unconsciously help
to encourage and to brighten the mind.
The convalescence of old people is always a slower
process than that of youth. They are likely to get de-
pressed and discouraged and need to be urged to new in-
terests more than younger people. They are so apt to
feel that it doesn't matter whether they get well or not;
that they wouldn't be missed ; that no one needs them.
They are very lonely. Nurses of experience have often
noticed this and how much happier such patients are if
some occupation can be found for them. With the young,
even if crippled, there is the hope of increased strength
and that muscles will grow stronger bit by bit with patience
and exercise. Convalescents have not the endurance to
work continually at one thing and the need of change in
occupation and frequent rest from work is not sufficiently
Suggestions for entertaining. Perhaps change of
ENTERTAINMENT OF PATIENTS 183
scene will provide more entertainment than anything else
and provision should be made for as much open-air work
The work of gardening implies a fairly strong person
but the lighter part of this is quite possible, such as plant-
ing seeds and watching them grow, watering and light
weeding. This proves quite interesting to both adult and
child, but the latter will have to be persuaded not to dig
up the seeds each day to watch their progress. Notice the
effect of work on a convalescent and see if the interest in-
creases or if they just keep at it with tense nerves as a
duty. If the latter is the case, try something else or lessen
the time devoted to one particular thing, and have some
other resource in mind to which you can direct their at-
It is often quite simple things and those which are at
hand that amuse and interest. Many an invalid enjoys
clearing out her desk drawer and looking over all sorts of
things that have accumulated, and also arranging the flow-
ers which gives a special interest in them, and even quite
sick patients like to do this.
To be able to play games of all sorts, including cards, is
a talent that can be used to advantage if the patient is fond
of that sort of thing, but play keenly and make them inter-
ested. There are a number of amusing games for two,
such as Chinese whist, Rummy, and always the standby
of solitaire (for either one or two people) ; also cribbage,
checkers, dominoes and puzzles of all sorts.
Among other suggestions might be mentioned: making
a scrap book with the patient, on any subject that inter-
ests; all sorts of clay modeling; stenciling, coloring pic-
tures; making knots; carving leather for bags or book
covers; knitting, crocheting and making baskets either of
reed or raffia or various things of crepe paper (flowers,
baskets, etc.). In arranging occupations, it is important
to gauge the strength of the patient and where the eyes
184 PRACTICAL HOME NURSING
are not very strong to choose the coarser patterns in any
work, and in making articles, such as a basket or knitting
a sock, encourage the worker to have a definite plan for
its use. If some personal interest can be connected with
it, so much the better.
Entertaining convalescent children. To meet the need
during a child's convalescence, it is equally necessary to
prevent their being overtired and overentertained as in
the case of adults. Do not give too many toys at one time.
Let the child get all the diversion he can from one and
when tired of that, take it away and give another. A
child will play with much less nerve strain when he is
evolving things himself than when closely observing what
another does. A little boy when he was sick received
numbers of beautiful toys and one was a mechanical toy
in a yellow cardboard box. The toy interested him a few
minutes; the box for two weeks, for out of the latter he
made all sorts of things with the help of some string, empty
spools, imagination and suggestions from the nurse. One
day it was a cart, another time a stable and just because
he had designed and planned it himself, it became very
precious to him.
Children become overtired if read to for a long time.
They will ask to have the reading continued but they don't
realize the strain of listening and are none the less over-
tired in consequence.
In convalescence a child's eyes should be carefully
guarded and no close reading or fine work of any sort al-
lowed no matter what the illness has been.
Children like to feel that a grown person understands
and sympathizes with their desires, but they play more
naturally when left to themselves and their own devices.
Some simple suggestions are : sailing boats in a basin
or bathtub; making soap bubbles from a simple clay pipe;
cutting paper dolls and dolls' furniture; making toys of
ENTERTAINMENT OF PATIENTS 185
cardboard boxes or flowers out of tissue paper ; rabbits
out of handkerchiefs ; studying birds and trees and flowers ;
planning little gardens; sewing dolls' clothes and knitting
for them ; modeling in clay ; putting picture puzzles to-
gether ; playing with mechanical toys ; making scrap
books of jokes or poetry clipped from magazines, or of ad-
vertisements and picture postals; coarse weaving (such as
horse reins), games of all kinds; collecting stamps; color-
ing pictures by using water color paints or crayons; col-
lecting stones, shells and all manner of things.
THE CAKE OF CHILDREN
From the time of birth, an infant requires intelligent
care in its helplessness, much as an invalid might. For
although this is a natural process it is often accompanied
by disorders, many of which are preventable by care and
Even if normal and healthy, children are frail and func-
tional disorders spread from one organ to another easily.
Whoever is in charge of little children must carefully
observe their condition and any symptoms that are un-
usual, such as the position a child takes, the sort of cry,
the hand going to the eye, ear, or any part of the body,
all of which may give a clew to what is causing the distress.
SPECIAL CARE OF NEWLY BORN INFANTS
The infant's eyes and mouth are washed with boracic
solution or boiled water, and this repeated as often as
necessary to keep them clean. Two to four drops of 20
per cent. sol. argyrol are dropped into the eyes with a
medicine dropper immediately after birth by the doctor,
to prevent ophthalmia, and cold compresses are afterwards
frequently applied. A dressing of dry sterile gauze and
powder is placed around and over the ending of the um-
bilical cord and held in place by a binder around the ab-
domen, and it must be kept dry until the cord falls off, in
about five days; after which pressure, by means of a pad
over the part, is maintained in the same way for some
Sweet oil or vaseline is rubbed over the skin including
the head, and the infant is wrapped in a warm blanket
THE CARE OF CHILDREN 187
and laid on the right side for some hours to free the heart
from any pressure. Later, the position should be changed
from side to side to promote active circulation in all parts.
A sponge bath is given with warm water (100°) and
castile soap at any convenient time during the first twenty-
four hours. (Child should not be put into the water until
the cord falls away.) The skin should be carefully dried
and powdered and the infant dressed in simple clothing.
For this will be needed a flannel band, 5 inches wide and
1 yard long, to place around the abdomen (later on this is
changed to a band with straps over the shoulders) ; a long-
sleeved shirt of wool and silk mixture; diapers of cotton
birdseye; a flannel and a muslin slip.
The urine and feces at this time are very dark in color
and will be until the contents of the intestines at the time
of birth have passed off.
Feeding. If a child is to be nursed by its mother, it
is put to the breast 6 to 12 hours after birth and for the
first few days about every four hours. The supply of
milk is scant at first and acts more as an aid to clear the
intestines than as a food until the third day, when the
breasts become normally full. If there is any discharge
from the eyes it is important to cover them before allowing
the infant to nurse, to prevent infection being carried to
the breast, and to wash the mouth before each feeding, and
the nipples of the breasts before and after each feeding,
with boracic solution. Have the nipples carefully dried.
If the infant is to be fed otherwise for the first day give
only sugar of milk and water, % oz. at a time, every three
or four hours. Then gradually begin modified milk in the
formula prescribed, starting with 1 oz. and slowly increas-
ing the amount as the capacity of the stomach increases.
This is given at regular intervals of three hours during
the day and once or twice during the night. Boiled water
given between feedings relieves thirst and aids normal
188 PRACTICAL HOME NURSING
functions and is very necessary, especially in warm
After the cord falls away a warm tub bath (100°) is
given daily. (See page 190.) The skin around the groin
and buttocks must always be kept clean, dry and well pow-
dered with rice powder or stearate of zinc, and diapers
changed frequently. There are two or three movements
from the bowels daily and the child sleeps most of the time
and needs good fresh air (not too cold) when sleeping; and
the eyes must at all times be shielded from direct light
falling on them and the infant kept quiet and the body
temperature taken (usually recording from 99° to 100°).
In raising the baby support its back and neck. Change
position of infants frequently enough while the cranial
bones are soft to allow proper molding of the skull.
Keep the nostrils free from discharge by swabbing out
with albolin on a little pledget of cotton. If stopped up,
the child is restless and breathes with difficulty.
GENERAL CARE OF SMALL CHILDREN
Normal development in the child depends largely upon
the freshness of the air it breathes, the nourishing quality
of the food and its suitability to the individual needs and
the climate; also upon cleanliness, the elimination of
waste, sufficient sleep and not too much excitement (this
reacts on the nervous system at that age).
The average weight of an infant is about 7 pounds at
birth and the usual gain is from 4 to 6 ozs. a week.
Occasionally there are intervals with no gain and this
should not be a cause of worry as the deficit may be made
up within the next few weeks, but usually week by week
and month by month there is a steady increase in weight.
Muscular development is gradual and natural and in-
creases as in adults from normal use of muscles. Cloth-
ing should not restrict the natural movements of the body
and the armholes should be made large. It is also to be
THE CARE OF CHILDREN
remembered that strain on the muscles of little children by
too long walks, too much exercise, too long intervals with-
out sleep are harmful and react on the nervous system
with the result of fretfulness, irritation, and unnatural
conditions for a healthy child. Teething occurs at vari-
ous ages, usually there are
6 teeth during the first year.
12 at 1/4 years.
16 at 2 years.
20 at 2% years.
This completes the first set. While teething is a normal
function, the child is often upset and fretful for a few
days, particularly in the case of delicate children. The
second and last set of teeth commences when the child is
about seven years of age and, completed, numbers 32. It
is most important that the first teeth be kept healthy by
having them clean, attended to and filled if necessary to
enable the permanent set to develop under healthy condi-
Nursery. Have a bright room for a nursery with dark
and light shades. Keep it well ventilated and evenly
heated at a temperature of from 65° to 70° during the
daytime and from 50° to 60° at night.
It is advisable to have everything in the room, such as
walls, floors, furniture, rugs, etc., of such a nature that
they can easily be kept clean. An enamel or brass crib
is desirable, fitted with a woven wire spring and a hair
mattress, or a folded blanket as a substitute, with a rubber
or quilted protector. Soft, hair pillows (not full) are
cooler than feather ones. Pillow cases and sheets should
be of smooth texture ; the blankets and spread very light
weight. In addition, all the necessary furniture, includ-
ing a screen, should be provided. It is a great conveni-
ence to have a table 30 inches high, 36 inches long, and 27
190 PRACTICAL HOME NURSING
inches wide with a board about 4 inches high forming a
rail around the top. This rail prevents the child from
slipping from the table when placed there to be bathed or
dressed or to have its diapers changed.
In an adjoining room there should be an ice-box and
some apparatus for heating water.
Bathing. A bath should not be given sooner than an
hour and a half after eating, because by thus drawing the
blood away from the stomach the digestion is interfered
with. For little babies the temperature of the bath is
100° ; this is gradually decreased to 90° as the age in-
creases. The room should be warm during bathing time
and without draughts. A baby's bath tub can be conveni-
ently placed on a stool or a table, or the regular tub in the
bathroom be used. A little baby may be dressed and un-
dressed on your lap (in which case wear a flannel apron,
useful to wrap around the child), or on the table above
described, or even on the crib, but this is not as convenient
a height. For larger children use either of the last two
methods. Have everything ready : — blankets, towels,
wash cloths, castile soap, cotton, powder, boracic solution
and lubricant, and warm clothing arranged in order as
Before putting the child in the bath, wash the eyes,
mouth, ears, nostrils and face (head, if required). Also,
with a girl-baby, wash carefully with boracic solution the
genitals, and with a boy press back the foreskin and wash
over the surface, then draw it in place again. ( A deposit
from the urine sometimes irritates these parts and causes
distress, restless sleep and loss of appetite.) Then take
the child on your left arm, and, holding the feet in the
right hand, lower into the water and bathe. If a child
has been frightened by the water at any time, overcome
this feeling by wrapping a soft blanket or a turkish towel
around the body before putting into the bath, so that it will
feel the water gradually and get over its fright.
THE CARE OF CHILDREN
It is considered a preventative to taking cold and a tonic
to the skin to accustom the child to a cold sponge after a
warm bath. When taken out of the bath, wrap the child
in a blanket or towel, dry carefully, especially between
every fold of the skin and powder surface where the mois-
ture might collect.
To dress, first put on the band, shirt, diaper (being care-
ful not to draw in the knees with the diaper), stockings or
booties. The skirt and slip may be put on together over
the head, avoiding touching the face with them.
The skin. At bathing time examine the skin care-
fully and see if there is any undue redness, irritation or
rash of any sort, particularly between the folds of the skin
at the neck, back of the ear, in the groiu and around the
buttocks. A child's skin is very sensitive and moisture
and heat combined may cause irritation and a breaking
down of the surface. Cleanliness and dryness are the
essential points to be remembered in order to keep the
skin healthy. This, of course, is aided by good nourish-
ment and sufficient exercise.
The mouth. Wash the mouth of the young child
morning and evening with a swab of cotton twisted around
the finger, and wet with sterile water or boracic solution
(1 part to 3 parts of water). Wash the roof of the mouth
without pressure from the finger and also swab around
the sides of the gums. When teeth are developed, clean
these carefully with cotton wound on a small wooden stick
or toothpick, and have older children rinse the mouth after
eating and use a soft toothbrush as soon as that is prac-
tical, particularly at night and in the morning.
Stools. While on a milk diet, an infant's stools will
be yellow smooth, with no curds and average from one to
two daily. A child can be trained to have at least one
movement at a regular time each day even in infancy, by
192 PRACTICAL HOME NURSING
being held over the receptacle with the legs drawn slightly
toward the body ; or suppositories of castile soap or gluten
are useful in helping to form this habit which is a very
important one for health's sake all through life.
Clothing. Clothing should be light in weight with
the undergarments sufficiently porous to allow for the easy
absorption of perspiration, and have the warmth evenly
distributed to all parts of the body, the abdomen being
especially well covered. Too much or too heavy clothing
causes excessive perspiration which is weakening. To
avoid taking cold, make changes in the weight of the
Sleep. A little baby sleeps most of the time and as age
increases is awake at longer intervals. At six months he
should sleep through the night 12 hours and also about 4
hours during the day ; at 1 year, about 3 hours during the
day. This day period is shortened as the child grows
older and until about six years of age at least, the habit of
sleeping an hour or even a half hour a day is an aid toward
the foundation of health by avoiding overtiredness.
Feeding. The normal food for an infant is human
milk and no other form of nourishment can quite compare
with it. The proportion of the different food elements in
human milk suits the needs and as the child grows this pro-
portion changes imperceptibly to meet its requirements.
An infant nurses from ten to twenty minutes and the mouth
should be washed out first and also the nipples of the
breast (which are also washed off afterwards) with boracic
acid solution. Regularity is important and there are
usually seven feedings allowed in the twenty-four hours
at intervals in daytime of three hours.
As a substitute for human milk some form of cow's
milk is prepared and given at the same intervals.
THE CARE OF CHILDREN
of cow's milk
. . 87 parts
. . 5 parts
. . 3.03 parts
Modified milk is cow's milk changed to resemble as far
as possible the qualities of human milk.
of human milk
Water 87 parts
Sugar 6 parts
Protein 2.02 parts
Fat 4.05 parts
Mineral Ash . . .03 parts
(Acid reaction) (Alkaline reaction)
Process of modifying milk. The milk is first diluted
to reduce the curd which is tough and not easily dissolved
(while that of human milk is flaky and soft). Diluting
also reduces the mineral salts.
Cream is added to increase the standard which was low-
ered by the dilution (see note on Top Milk).
Sugar of milk or some other form of sugar, such as
maltose, is added to make up for the deficiency in cow's
Lime water is frequently added to neutralize the acidity.
The water used in this feeding must always be boiled
and cooled. Cereal, in such a form as barley water, is
sometimes substituted for the boiled water, partly for its
food value, but more especially, to aid in preventing large
curds from forming.
If necessary to make this food sterile it is pasteurized.
The food is strengthened by increasing the amount of
milk and decreasing the proportion of water. When the
quantity is increased it is at the rate of about % to 1 oz.
at each feeding.
Top milk. This represents a higher percentage of fat
than in the ordinary bottle of milk. Instead of diluting
the milk and then adding cream to raise the standard
194 PRACTICAL HOME NURSING
again, top milk is used, in which the percentage of cream
is larger to begin with.
Method. Have an average bottle of milk which repre-
sents 4 per cent, fat, stand four hours. Remove the upper
16 ozs. with a cream dipper or syphon without disturbing
the rest of the contents of the bottle. This represents 7
per cent, cream, and from that take the amount required
for the day's feedings.
Top milk table.
Upper 16 ozs. equal 7 per cent, of fat
Upper 20 ozs. equal 6 per cent, of fat
Upper 25 ozs. equal 5 per. cent, of fat
The whole bottle shaken together represents 4 per
cent. fa +
Examples of formulas.
Age: 2 weeks
Top milk (from up-
per 16 ozs.) .... 6 ozs.
Lime water ....... 1 oz.
Milk sugar ( 1 oz. )
Boiled water 13 ozs.
Age: 4 weeks
Top milk 8 ozs.
Lime water 1 oz.
Milk sugar (1 oz.)
Boiled water 11 ozs.
Milk sugar is not counted in the amount of the feeding
as it dissolves into small space.
Unless the doctor decides on the exact formula to use
it is advisable to be governed by the directions in such
books as Dr. Holt's " Care and Feeding of Infants," Dr.
Kerley's " Talks with Young Mothers," or various books
by other authorities on this subject. These give the aver-
age formulas suitable for the different ages and sugges-
tions for the feeding of older children.
THE CARE OF CHILDREN
Method of preparing feedings for twenty-four
Protect all feeding utensils, bottles, nipples, and food
Don't fail to wash the hands before preparing the food.
All the utensils should be boiled and cooled before
The articles needed are : —
A dish pan (to boil utensils in).
A pint measuring glass.
The required number of bottles.
Funnel for filling the same.
Cream dipper (Chapin dipper).
1-2 bottles of milk. (The best and freshest milk
you can afford to buy. )
Boiled water or cereal water, cooled.
Lime water (if necessary).
Milk sugar (lactose).
Sterile cotton stoppers (see page 54).
Method. Add the milk to the water in which the
sugar has been previously dissolved, and also lime water if
used. Mix these together and place in each bottle the
amount required for one feeding and cover with the stop-
per. If necessary, this is then pasteurized (see page
36). If not, the bottles are placed directly on the ice
and left there until needed. An ice-box is obtainable in
which the center part contains the ice and the bottles
placed in separate divisions can touch it directly. Other-
wise the bottles must be placed in a wire holder and this
in the general ice-box, touching the ice.
Heating the food. Shake the bottle to mix and place
it in warm water deep enough to cover the milk m the
196 PRACTICAL HOME NURSING
bottle. When warm, remove the stopper and with the
inside part of it wipe off the edge at the top of the bottle.
Then test for heat by pouring a drop on the wrist or on a
spoon from which it can be tasted. Adjust the nipple
and when giving it to the child, see that the milk is always
in the nipple by holding the bottle at a good angle, and
remove before it is empty, otherwise air is drawn in, caus-
ing distress. Also see that it is taken slowly, as drinking
milk too quickly allows it to form too large curds in the
Care of bottles. After each feeding, these should be
immediately washed out in cold water then in soap suds
and boiled before using again.
Care of nipples. Boil these, when new, for two min-
utes. After use, they should be washed out carefully in
cold water and once a day turned inside out and washed
with a brush ; then kept in a covered dish in sterile water
or boracic solution till needed. Make two holes in each
nipple with a red hot, fine cambric needle. At least three
nipples should be ready for use.
Water is given independently of food, between feed-
ings. It is frequently necessary to substitute other foods
temporarily for milk such as whey, barley water, Imperial
Granum, white of egg, rice water, malted milk, etc., and
the regular diet must be resumed gradually.
Fruit juices are added to the child's diet at varying
ages from the sixth month up, starting with two teaspoons-
ful and increasing the amount to 2 ounces and more ; the
same with beef juice particularly where the milk is pas-
teurized, as some of its value has thus been destroyed.
Cereals in various forms are also added to food.
In sudden hot weather, dilute the food, whatever it
is. At any sign of illness, dilute the food and make the
return to normal food very gradual.
Method of restraining the arms.
THE CARE OF CHILDREN 197
Describe the special care a baby needs for the first few
hours of its life.
If not nursed by the mother what food will child have for
first 24 hours ?
What special care does the mouth need ?
What is the danger to the child from sore eyes? — to the
Mention points in care of a child for its comfort.
How should a baby be lifted up ?
What is the usual gain in weight?
Describe a suitable nursery and convenient furnishings.
Describe method of bathing a child.
How prevent chafing of skin ?
What is modified milk?
Why should the position of child be changed frequently?
CAKE OF SICK CHILDREN
Most of the qualities required in general nursing apply
in the care of sick children and more — more patience
and tenderness, more firmness, tact and good judgment
and better control of the voice.
When taking charge, if you are a stranger to the sick
child, make your presence known gradually and try and
gain his confidence quietly. Closely observe symptoms
such as sore throat, rash, stools — condition and color, po-
sition, character of sleep, and the cry, whether sharp,
moaning or fretful.
RESTRAINING A CHILD
To restrain a child from touching a sore place, scratch-
ing pimples or during the dressing of a wound or when
giving medicines or treatment :
1. Place a sheet folded diagonally under the child ex-
tending from the shoulders down and lay the child's arms
down straight on either side of its body and fold the sheet
firmly around and pin it. (This can be made long enough
to include legs if necessary.)
2. Place mittens on the hands and fasten to the under-
shirt sleeve with safety pins. Have tape attached to the
finger end of these and tie the tape to the bed loosely
which prevents the child from getting the hands to the
face while perfectly able to move the arms comfortably.
The same arrangement for the feet can be devised if
3. A softlv padded splint can be bandaged on the arm
Method of restraint.
CARE OF SICK CHILDREN
from the hand to beyond the elbow point. This allows
free movement of arm, yet the child is unable to reach the
4. Restraint for an examination or treatment of
the throat, nose, eyes, or ears.
Method i. Restrain the child's arms as described;
then place the child on your lap, facing the examiner, and
place one of your arms across the child's body and the other
hand against forehead to steady the head. *With a larger
child use above method but instead of sitting on your lap
the child must stand in front of you; then you can cross
one of your knees over the other to hold the legs firmly.
Method 2. Place the child in your lap, have him face
the examiner, then put your right and left arms under the
right and left arms of the child — by bringing up both
your arms, you raise the child's arms and thus keep them
out of the way of the examiner or operator. With both
your hands on the child's forehead, you can raise or tilt
the head while your knees crossed are securely keeping the
child from struggling, and in that way you give the exam-
iner a clear field for examination or treatment.
When a child of any age becomes ill it is always wise :
To take the temperature and examine the throat to
find out if the trouble is there ;
To give a warm bath which will relax the muscles,
soothe the nerves and may bring out any latent rash
under the skin ;
To look for a rash on the skin ;
To give a laxative or an enema ; and
To dilute whatever food the child is taking by half.
This food is easily increased and undigested food only
complicates conditions. Isolate from other children until
assured that there is no infection.
200 PRACTICAL HOME NURSING
Fever is not in itself a disease but is one of the symp-
toms of some disorder and in a child this may arise from
slight causes such as constipation, cold, indigestion; or it
may be the initial symptom of serious illness depending
on the degree of rise in temperature.
Treatment. It is always safe to try and reduce the
temperature by means of a sponge bath with alcohol and
water, half and half, or by a tub bath at a temperature of
85°. This will cool the skin, quiet the nerves and induce
sleep. Also keep cold to the head, give an enema or laxa-
tive, dilute the food and have the patient drink plenty of
cool boiled water.
Vomiting may be a symptom of disease but usually is
due to irritation of the stomach from various causes such
as acidity in the stomach, food given at too short or ir-
regular intervals, too much at a time or unsuitable in
kind. Vomiting may also be caused by the effect of heat
or of nerve strain.
Treatment. If severe, cut off all food and give only
boiled water with a little soda or lime water in it. Try
to induce sleep to quiet the nerves of the stomach and
when feedings are resumed, start with very small quanti-
ties of white of egg or barley water or whey at regular
intervals and keep the child quiet, lying down in a semi-
darkened room. If a child shows a tendency to vomit
after feedings, omit one feeding or give water in its place,
make the intervals longer, give less in quantity, and keep
the child quiet and in good fresh air. If this is not suc-
cessful, the necessity of a change of food is indicated.
Prevent the child becoming overtired, provide fresh air,
a cool and darkened room. See that the bowels are
CARE OF SICK CHILDREN
acting normally, that there is no irritation on any mucous
membrane nor irritation or chafing of the skin, that the
nostrils are free and the breathing easy, also notice if the
child breathes through the mouth and if so, raise the
head a little for relief and call attention to this symptom,
for this in itself makes restless sleep. Have the child
comfortably warm but the bed clothes light in weight and
not too plentiful. A warm foot bath just before bedtime
is soothing and quieting.
INCONTINENCE OF URINE
If a child cannot control this function, an examination
by a physician will be necessary, but if purely from a
bad habit, it can usually be overcome by having the child
avoid fluid at the evening meal and not drinking any after
that and pass urine just before going to sleep. The bed-
clothes should be fastened securely to prevent the child
from feeling cold. A bath towel tied around the lower
abdomen with a good knot over the lower part of the spine
to keep child from sleeping on its back also helps overcome
With vaginitis there is a catarrhal discharge from the
vagina and in many cases this is of an infectious nature,
especially to mucous membrane and other children must
be guarded from danger of this infection.
Treatment. The vagina is washed out with boracic or
saline solution frequently and all cloths or utensils must
be disinfected, and the diapers boiled and not even then
used for other children. The general health of the child
must be improved. Your own hands should be thoroughly
disinfected after touching that part to avoid carrying in-
fection to the mucous membrane of the child's mouth or
eyes and for your own protection.
202 PRACTICAL HOME NURSING
Prickly heat is an irritation on the skin which rrakes
any child fretful and restless. It comes as the result of
heat, moisture on the skin or from too heavy clothing.
Symptoms. The skin is covered with a rash of tine
pimples that burn and itch.
Treatment. Relief is best obtained from bathing the
body frequently, either tub or sponge baths, using soda or
bran instead of soap and water. Use plenty of water if
giving a sponge bath and no rubbing, just pat the skin dry
with a soft linen cloth and powder freely and often.
Powder seems to relieve more than lubricants in this case.
Use linen or silk next to the skin to prevent irritation from
the underclothing and dress with the lightest of clothing.
Prickly heat often causes digestive disturbance and there
should be free action from the bowels. To maintain this,
milk of magnesia is often added to the milk and plenty of
water given to drink.
OTHER IRRITATIONS OF THE SKIN
Boils. A boil comes from some infection taken in
through the skin which causes an inflammatory condition
of the part. Until a physician sees it, keep a cold wet
dressing of boracic solution or water over the boil and sup-
port the part and keep it quiet.
Hives. See page 138.
Chafing of the skin. Use powder freely, which is
usually enough treatment, but if the outer skin is broken
or very much irritated, rub a little oxide of zinc ointment
or cold cream and Pond's extract on the surface. For
sore lips, camphor ice is soothing.
Indigestion may vary from a slight disorder to a seri-
ous condition and is caused by the lack of proper digestion
of food. This is shown in the stools, usually by the pres-
ence of curds and often mucus.
CARE OF SICK CHILDREN
Treatment. The diet should be changed or the same
type of food diluted and given in smaller quantities. In
many cases this condition is overcome by a change of air,
by an improvement in general living conditions, and by
normal exercise, but in some cases, if patient is very much
exhausted, rest is called for.
Colic is usually a result of gas or air in the stomach or
intestines, or it may be indirectly due to constipation or
unsuitable food, or to cold.
Symptoms. As the gas presses on sensitive parts and
on nerves, the pain is very sharp and severe and the child
instinctively draws up the legs towards the body as this
position relaxes the muscles of the abdomen which are
tense and hard. The child's cries are hard and strong
and are repeated at intervals until relieved.
Treatment. If the gas is in the stomach, put the child
over your shoulder and pat the back. Give warm water
with a little bi-carbonate of soda in it or peppermint. Lay
the child, face downward, with the abdomen over a hot
water bag for heat and pressure, which relieves the pain,
or put the feet in hot water and mustard, lubricating the
feet first to prevent the skin being irritated. If the colic
is severe, an entire hot bath can be given which relaxes the
muscles, allowing the gas to pass off more easily. An
enema of soap suds with ten drops of turpentine added to
it will usually give the quickest relief, or even inserting
the rectal tube and leaving it in the rectum aids in ex-
pelling the gas. Rubbing the abdomen also provides re-
Diarrhoea comes from an irritation to the muscles of the
intestines and mav be caused by various conditions; as
cold, indigestion, 'disease, etc. The stools are thm or
204 PRACTICAL HOME NURSING
watery, usually an unnatural color (green instead of yel-
low) and too frequent.
Treatment. Keep the child warm and in bed or at
least quiet. Clear away the irritating cause by a dose of
castor oil or some laxative. (Calomel is frequently or-
dered in such cases to stimulate the liver to secrete more
bile which is the natural fluid that clears the intentines.)
Keep the abdomen and feet warm and prevent chafing of
the buttocks. After the oil has taken effect, saline irriga-
tions quiet the intestines and relieve thirst. For diet,
give the class of food that is digested mainly in the stom-
ach, such as condensed broth and barley water, white of
egg and arrowroot gruel. When the condition is improved,
increase the diet gradually.
When there is a tendency to constipation, rub the abdo-
men night and morning with warm olive oil — the direc-
tion for rubbing is up the right side, across the top and
down the left side — to stimulate the intestinal muscles.
Establish regular habits to have a movement at the same
time each day. If necessary, use suppositories of castile
soap, gluten or glycerine or even an oil enema or one of
soap suds to help overcome this difficulty, but these aids
should be discontinued as soon as possible. The main
point is to regulate the diet by giving an increase of fats,
sugar, fruit juices (independently of food), green vegeta-
bles — if the child is old enough to have them in the diet
— the coarser grained cereals and breads. Milk of mag-
nesia is often added to milk for its laxative effect. This
gives no taste to the milk and is only for temporary use.
Lime water, when included in milk formulas, has fre-
quently to be temporarily discontinued as it tends to con-
CARE OF SICK CHILDREN
SUMMER DIARRHCEA OR CHOLERA
This may quickly become serious and needs the advice
of a physician. The immediate distress is in the digestive
tract and both stomach and intestines are involved. The
indirect causes are usually heat, overfeeding, impure air,
and it may be aggravated by teething.
Symptoms. There is vomiting and diarrhoea, with
stools green in color, watery and containing mucus, fever,
loss in weight and appetite, thirst, restlessness, and ex-
treme general weakness.
Treatment. Give a dose of castor oil to clear away
any irritating substance in the intestines and after the oil
has caused a free movement, give a saline irrigation (see
page 100). This relieves thirst through the absorption
of fluid into the tissues and quiets the intestines as well as
serving to wash away any foreign substance. Keep the
child cool, quiet and in the open air, and if possible se-
cure an entire change of air from the city to seashore or
Use vaseline in the entrance to the rectum and over the
buttocks as the acidity of the stools at this time irritates,
and powder applied is not enough to prevent it. Also put
a soft cloth to be worn inside the diaper.
Remove milk from the diet for the time being and give
barley or rice water, white of egg, and, when resuming
milk, grade the amount carefully.
THRUSH OR SPRUE
Thrush is caused in most cases by uncleanliness of the
mouth, and appears in white, flakey spots in the mouth.
Sometimes every part is covered and again it appears only
on the inside of the cheeks and gums. This distresses the
child, making it difficult and painful to take food. The
spots sometimes extend through the digestive tract to the
206 PRACTICAL HOME NURSING
Treatment. Wash out the mouth with boracic solution
after each feeding aud swab over the surface inside the
mouth several times a day with bicarbonate of soda or
borax — one teaspoonf ul to half a glass of water ; avoid
pressure as these spots must not be rubbed off.
If a child is hoarse or complains of a sore throat or has
difficulty in swallowing, look into the throat and see if
there is any sign of membrane there, if it is red and in-
flamed or if it has white spots on it. It is never safe to
take anything for granted about a sore throat and it should
at once be reported to a physician.
Treatment. For immediate relief, apply a hot, wet
flannel to the outside of the throat or ice cold applications
(ice bag or ice cold cloths), or a flannel soaked in cam-
The throat can be sprayed with an astringent solution
or, if the child is old enough, use a gargle of the same (see
Give general treatment to reduce fever, a laxative or an
enema, plenty of water to drink and a fluid diet.
COLD IN THE HEAD OR CHEST
For a slight cold in the head or chest, take the temper-
ature, put the child to bed for a few days, or if around the
house, guard from draughts, keep on a very light but
nourishing diet with plenty of water. Give a warm bath
and a laxative, and for local relief, wash out the eyes with
boracic solution and swab the nostrils with albolin or vase-
line to make breathing easier, rinse the mouth frequently
and if the throat is inflamed use a simple gargle or spray
and rub the outside of the throat and chest with camphor-
ated oil or with this and turpentine mixed in equal parts.
After any illness the important point is to build up the
system with nourishing food, good air, plenty of sleep and
CARE OF SICK CHILDREN
general care so that the resistant power will be increased
and there will be less likelihood of a return of that or any
other sort of illness.
Describe methods of restraining a child.
What would you do for a child when it becomes ill?
State the usual causes of vomiting.
Give signs of indigestion.
How would you reduce fever ?
Give treatment for diarrhoea.
What change in food can be made to overcome constipa-
Mention means that could be taken to quiet a restless child.
Mention points to observe about the condition of sick
Don't fail to remember that tact, patience and self-
sacrificing endurance are essential in the care of the sick.
Don't tell the patient what medicine is being given.
Leave that for the doctor.
Don't discuss the patient's condition with the doctor in
the presence of the patient if it is possible to avoid doing
Don't remain in the room every minute of the doctor's
visit. He may have something to discuss with the patient
without you. This rule should also apply to visitors.
Don't whisper in a sick room or just outside, in the
hearing of the patient.
Don't employ spare time in gazing at the patient, and
do not rock in a rocking chair.
Don't rattle a newspaper.
Don't judge the temperature of a sick room by your
own feelings. Use a thermometer.
Don't make too many explanations to the family about
things you need for treatment; don't frighten them un-
Don't knock against the bed in passing.
Don't move or uncover a patient more than is necessary
in giving a bath or any treatment.
Don't fail to have things ready before beginning a
Don't hurry your patient by seeming to be in a hurry
Don't make larger washings than are necessary by care-
less use of linen.
Don't rub your eyes, or touch your face when dressing a
wound, or after caring for the sick.
Don't talk too much.
Don't forget that it is an accepted fact that the mind
has a great effect upon the body.
Don't wake up the patient for food, medicine or treat-
But don't neglect to wake the patient for food, medicine
or treatment if it is the doctor's order.
Don't tell about former cases ; if asked, be discreet.
Don't comment on the patient's appetite to the patient
but observe this carefully.
Don't forget that care in serving food attractively will
often tempt the appetite.
Don't fail to aid the doctor by obedience to his orders
and by loyalty to him.
Don't fail to be dignified.
Don't take unnecessary steps or tread heavily in the
Don't fail in kindness of heart, and in sympathetic un-
derstanding of the needs of your patient.
Don't fail to act calmly and wisely in an emergency.
Abdomen. Cavity between the chest and groin. It lies be-
low the diaphragm and is the largest cavity in the body.
Absorption. The sucking up of fluids or other substances by
Aesophagus. The canal extending from mouth to stomach.
Albumin. A protein substance found in animal and many
vegetable foods. It dissolves in cold water — coagulates or
thickens by heat.
Alimentary canal. The tube extending from the mouth to the
anus — about 28 feet long.
Antiseptic. An agent which prevents the growth of bacteria.
Anus. The external opening of the rectum.
Appendix. A small tube connected with the large intestine
at a point on lower right hand side of abdominal cavity.
Arteries. Vessels through which blood is distributed from
the heart to all parts of the body.
Astringent. An agent producing contraction of the tissues
and thereby checking the secretions.
Axilla. The cavity under the arm at its junction with the
Bacteria. A form of plant life — germ — microbe.
Bile. The secretion of the liver.
Bladder. A sac that acts as a reservoir for urine with capacity
of one pint. It forms front of pelvic cavity.
Blood. The vital fluid of the body — circulating through heart
and blood vessels.
Bone. Tissue forming the skeleton of the body.
Brachial. Relating to the arm
Bronchial tubes. Air passage extending from the trachea into
Capillaries. Small blood vessels connecting arteries and veins.
Carbohydrates. Food substances which include sugars and
Carbon dioxide. Carbonic acid gas, an important constituent
of exhaled air.
Catarrh. Inflammation of mucous membrane accompanied by
Cathartic. Medicine to cause a movement of the bowels.
Cell. A minute part of a living substance.
Chest. The cavity extending from throat to abdomen.
Clavicle. Collar bone.
Chyle. The milky fluid which is the result of intestinal diges-
tion of food.
Chyme. The fluid into which food is changed by stomach di-
Colon. The large intestine.
Congestion. An accumulation of blood in one part.
Constipation. The retention of feces that normally should be
expelled by muscles of tbe intestines.
Convulsion (Spasm). Involuntary contraction of the muscles.
Corpuscle. A small body or cell.
Counter irritant. An agent used to irritate the surface and
draw blood from the deeper parts.
Crisis. The turning point of disease. A sudden change.
Croup. Inflammation of the larynx and trachea causing diffi-
Curds. Coagulated proteid of milk containing some fat.
Cuticle. The outer or scarf skin.
Decomposition. The decay of a substance caused by bacteria.
Deodorant. An agent that destroys odor — fresh air — chemi-
Diaphragm. The muscular wall separating the chest and abdom-
Diarrhoea. Frequent and too fluid evacuations of the bowels.
Digestion. The process of changing foods to prepare them for
absorption into the tissues.
Disinfectant. An agent that will kill germs.
Dorsal. Pertaining to the back.
Douche. A stream of fluid directed into a cavity or over a
Duct. A tube through which secretions from a gland are con-
Emetic. An agent to produce vomiting.
Enema. Fluid injected into the rectum.
Eruption. A breaking out.
Eustachian tube. The canal leading from the middle ear to the
Expectorate. To spit up mucus from the throat or lungs.
Faint. Loss of consciousness caused by too little blood in the
Fecal matter. Discharge from bowels mainly the residue of
food that has not been absorbed.
Femur. The thigh bone.
Ferment. Is an agent that can break up a complex substance
into simpler substances.
Fibula. The smaller of the two bones of the leg.
Flaxseed meal. Meal ground from seed of flax — used for
Foreign body. Any substance that does not normally belong
in the part where it is.
Fomentation. An application of moist heat — cloths wrung out
of hot fluid and applied over a part.
Fracture. The breaking of a bone.
Fumigation. Disinfecting by gas, vapor or heat.
Function. Natural action or use of a part.
Gastric juice. The digestive fluid secreted by glands of the
Genitals. Pertaining to generative organs.
Glands. An organ whose function is to produce a secretion.
Groin. Depression between abdomen and thigh.
Health. Normal condition — free from disease.
Heart. A muscular organ situated in chest cavity which forces
the blood into the arteries.
Hemorrhage. An escape of blood from a blood vessel — Arterial
— Venous — Capillary.
Humerus. Bone of the upper arm.
Humidity. Excessive moisture of the atmosphere.
Intestines. The alimentary canal extending from stomach to
Indigestion. Lack of normal digestive power.
Infection. The communication of disease germs.
Inhalation. Breathing in of vapor or fumes.
Intermittent. Occurring at intervals.
Incontinence. An involuntary evacuation of feces or urine.
Isolate. To separate one from another — to keep apart in or-
der to prevent spread of infection.
Irrigation. A flow of fluid over a surface or wound or into a
Kidneys. Two organs lying in the hollow of the back on either
side of the spine. They secrete urine from the blood.
Kumyss. Fermented milk made with yeast.
Lactose. Sugar of milk — an easily digested form of sugar.
Ligaments. Strong bands of fibrous tissue which hold bones
together at joints.
Liniment. A mixture of a drug and oil for external use.
Lubricant. An oily substance that makes smooth when applied.
Massage. Scientific rubbing and exercising of the body to
stimulate tissues and muscles.
Muscles. Organs of motion composed of strong muscular tis-
sue, capable of contracting or relaxing.
Membrane. Thin tissue lining the cavities of the body and sur-
rounding some organs.
Narcotic. Producing stupor.
Nasal. Pertaining to the nose.
Nausea. The sensation that makes one desire to vomit.
Nerve. A fiber conveying impulses and sensations to and from
the brain and spinal cord.
Nitrogen. A gas or element of the air.
Nozzle. A tip end — glass or rubber — with an opening.
Nutrition. That which nourishes — food.
Ointment. Soft, greasy substance for external use.
Ophthalmia. Inflammation of the eye.
Organ. A part of the body which exercises special function.
Ovum. An egg.
Oxygen. The gaseous element that supports life and an im-
portant constituent of inhaled fresh air.
Pancreas. A glandular organ secreting pancreatic juice; this
is conveyed to the small intestines to assist in digestion of
Paralysis. Loss of motion or sensation to any part.
Patella. Kneecap; a round bone in front of the knee joint.
Peptonized. Food partially digested by artificial means.
Periosteum. The membrane surrounding bone.
Peristaltic action. The peculiar wave-like contraction of muscles
by which the contents of the stomach and intestines are
Perspiration. Fluid secreted from the blood by the glands of
Phlegm. Thick expectoration coughed up.
Piles. Enlarged veins about the rectum.
Pleura. The membrane covering the lungs.
Poison. Anything taken into the system or developed in it
that endangers life.
Pores. Small openings on the surface — as on the skin.
Poultice. Moist external application made of meal or any bland
Ptomaine poison. Poison usually produced from decomposition
of food by bacteria in the alimentary canal.
Pubes. The front part of the pelvis.
Pulse. The beat felt in the arteries from the contraction of
Radius. Bone of lower arm on the thumb side.
Rash. An eruption on the skin.
Rectum. The lower portion of large intestine with function to
Residue. Waste from body tissues and what is left over of
food after normal absorption.
Respiration. The act of breathing which has two parts — in-
haling and exhaling.
Skeleton. The framework of the body.
Spinal. Relating to the spinal column.
Spores. The seeds of some types of germs.
Sprain. An injury to or stretching of a ligament.
Sterile. Free from germs.
Sterilize. To destroy bacteria on a surface or in a substance
Sternum. The breast bone.
Stimulant. An agent that excites activity in the function of
Stomach. An enlarged portion of the alimentary canal lying
between aesophagus and small intestines. It retains food
during part of the process of digestion.
Strain. An injury to or stretching of a muscle.
Subclavian. Under the clavicle bone.
Suppository. A cone shaped substance that will dissolve to be
introduced into the rectum, etc. A drug is sometimes in-
cluded in this substance.
Synovial fluid. The fluid that lubricates a joint.
Temperature. The degree of heat according to some definite
Thermometer. An instrument to determine the heat according
to a chosen scale.
Tibia. The larger of the two bones of the leg.
Tissue. A combination of cells with a special function.
Trachea. The air passage from the throat to the lungs.
Tuberculosis. A germ disease in which the affected tissue de-
teriorates — wastes away.
Ulna. The bone of the lower arm on the inner side (little
Umbilical. Relating to the navel.
Urea. The chief solid part of urine.
Urine. Fluid secreted by the kidneys from the blood. A form
of waste from the body.
Uterus. Female generative organ situated in the pelvic cav-
Vagina. The canal leading to uterus from the vulva (external
Veins. Vessels conveying blood on its return to the heart from
all parts of the body.
Ventilation. Changing the condition of air. Admitting pure
and expelling impure air.
Vertebrae. Bones of the spinal column.
Abdomen, 4, 107, 125
Acid, 120, 156
Aesophagus, 4, 21, 25
in lungs, 12
cushions, rings, 94
Alcohol, as antiseptic, 57
stimulant, 118, 141
Animal food, 24, 30
Antiseptic, 52, 53
to tempt, 27
Appliances, 70, 72, 94
to control hemorrhage, 146
Artificial respiration, 150
in wounds, 51
in food, 27
figure of eight, 165
recurrent of the scalp, 178
spiral reverse, 166
alcohol sponge, 84
temperatures of, 80
Barley water, 36, 193
making, 65, 66
changing, 67, 6S
relieving weight of, 70
Bedside notes, 128
Bedpan, 92, 98
Bichloride solution, 57
Bladder, 4, 18, 19
Blood circulation, 9, 10, 127
pressure, tests, 9
Bones, 1, 3, 142
Boracic acid, 57
Brachial artery, 146
Brain, 4, 7, 141
Breathing, 6, 141, 157
Bronchial tubes, 11
Burns, 148. 151
Carbolic acid, 57
Carbon dioxide, 44
Catarrhal cold, 138, 206
Cathartics, 119, 204
Castor oil, 119
Cell, 1, 49
Chyle, chyme, 25
bathing of, 190
care of sick, 198
common ailments, 200-207
entertaining of, 184
Coffee, 38, 99, 118
Cold applications, 113
Cold in head, 138, 206
fracture of, 143
Constipation, 133, 204
Convalescence, 181, 184
Counter irritants, 1 ' 1
Cranial cavity, 4
Comfort of patient, 115
Compress hot, 109
varying of, 27
process, 23, 25
of clothing, 56
Dorsal position, 132
Ear, earache, 136
foreign body in, 153
irrigation of, 102
Electric shock, 151
Emetics, 118, 156
Entertainment of patient, 180
Epileptic fit, 155
Eruption, 126, 138
Eustachian tube, 88, 103
compress for, 104
foreign body in, 153
irrigation of, 104
Fallopian tubes, 129
Fats, 24, 25
Fecal matter, feces, 29, 127
helpless patient, 28
Modified milk, 193
preparing of, 195
Femoral artery, 146
Fever, 16, 135, 200
Figure of eight, 165
overcome by smoke, 150
Flaxseed meal poultice, 110
care of, 27
digestion of, 23
serving of, 28
Foot bath, 85
Frost bite, 150
Gastric juice, 22
Generative organs, 4, 129
Glands, 5, 7, 79
Groin, 146 ■
care of, 87
washing of, 86
vermin in, 87
Heat, dry, 106
Heart, 9, 141
arteries for controlling, 146
Hot water bag, 106
caie of ice box, 29
Incontinence, 10, 201
bathing of, 190
feeding of, 187
Inhalation, 118, 141
Intestines, 4, 22, 23, 1 19, 134
Jaw, dislocation, 144
Joints, 5, 143
Knee bandage, 168
Larynx, 11, 159
Ligaments, 1, 5
Lifting, methods of, 74, 75
Lime water, 193
Liver, 4, 21, 23
Lungs, 4, 10, 11, 14
changing of, 69
altering conditions of, 31
infant feeding, 187, 192
pasteurized, 30, 36
sterilized, 31, 37
Mineral food, 32
Mouth, care of, 88, 186, 191, 205
methods of, 74-78
Muscles, 1, 5, 90
Mustard paste, 111
Narcotic poisoning, 157
Nerve strain, 8, 132
Nervous system, 7-8
changing of, 70
Nipples, care ff , 196
Occupations for convalescents,
Origin of the body, 1
Ovaries, ovum, 129
Oxygen, 7, 44
Pancreas, 4, 21, 23
Paralysis, 8, 93
Pastel la, 3
Pasteurized milk, 30, 36
Peptonized milk, 31, 36
Perspiration, 7, 79, 81
Peristaltic action, 5, 21
arranging, 71, 72
Pores, 7, 79
Positions, 125, 132
Pulse, 12, 13, 14, 127
Radial artery, 13
Rash, 126, 191, 198, 202
beef juice, 40
beef tea, 40
albumen water, 35
coffee, 38, 43
rice water, 35
coffee cream, 43
rennet or junket, 43
Rectum, 4, 15
Respiration, 11, 12, 127
Restraint, methods of, 199
Retention of urine, 19
Rubber, sheets, 65
tubes, 96, 97
cushions, rings, 94
Saline solution, 56
Sheets, 65, 67
care of, 62
Skin, 7, 79, 126, 191
Sleep, 124, 192, 200
Soda bicarbonate, 120, ,.49
Spica bandage, 166, 168, 170
Spinal canal, 4
cotton, gauze, 54
Stimulants, '.)'.), 117, 141
Stomach, 4, 2i, 22, 25
Structure ot body, 1-8
Subclavian artery, 146
Symptoms, 123, 186, 198
Synovial fluid, 5
Tea, 37, 118
Teeth, 88, 189
reducing of, 16
as symptom, 127
Thermometer, 15, 16, 61
Throat, sore, 139, 206
foreign body Li, 154
irrigation of, 103
Tongue, 88, 127
Trachea, 1 1
Tube, rectal, 97
Umbilical cord, 186
Urine, 18, 19, 127
Vagina, 129, 131
Vegetable food, 32
Vena cava, 10
Ventilation, 44, 46
in hair, 86
Vertebrae, 2, 3
Waste, 12, 16, 25, 79
Water, 24, 29
Wasp bite, 154
Wound treatment, 51
PEINTED IN THE CNITBD 8TATES Or AMERICA
""THE following pages contain advertisements of a few
of the Macmillan books on kindred subjects.
Home Nursing; Modern Scientific
Methods for the Care of the Sick
BY EVELEEN HARRISON
I2mo, 235 pp., with appendices and index; bound in half-leather.
The experienced nurse must often be asked many ques-
tions as to simple remedies, the proper nourishment under
special conditions, or the care of convalescents. At other
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stead of being allowed to create a permanent weakness
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little book should prove a valuable service.
The New Public Health
BY HIBBERT WINSLOW HILL
Of the Institute of Public Health, London, Ontario, Canada
Cloth, i2tno, $1.25
Dr. Hill has analyzed the revolutionary changes that
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ticularly in reference to the public health of the future, and
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veloped in recent years. Tuberculosis, scarlet fever, and
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The book is optimistic, constructive, and enthusiastic ; it
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it is authoritative and founded on long actual experience.
THE MACMILLAN COMPANY
Publishers 64-66 Fifth Avenue New York
RECENT IMPORTANT BOOKS FOR NURSES
Public Health Nursing
By MARY S. GARDNER, R.N.
WITH AN INTRODUCTION BY
Miss M. ADELAIDE NUTTING
PROFESSOR OF NURSING AND HEALTH, TEACHERS COLLEGE
COLUMBIA UNIVERSITY, NEW YORK
Cloth, i2mo, 372 pp., $1.75
Probably the best description of this unusual new book is
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THE MACMILLAN COMPANY
Publishers 64-66 Fifth Avenne Hew York
Dietetics for Nurses.
By FAIRFAX T. PROUDFIT
Formerly Instructor of Nurses in the Lucy Brinkly Hospital.
Outside of Materia Medica and Anatomy and Physiology,
probably few subjects in the training of pupil nurses are of
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time. The former mistaken view, that Dietetics begins and
ends in the diet kitchen, is probably responsible for this
lack, but in this text the author has placed the food prepara-
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in a form which is both interesting and scientifically correct.
The book is divided into three sections : First, Prelimi-
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tetics, which includes the study of all diseases affected by
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ing, the nurse must have a first hand knowledge of food
materials and their relation to the normal body before un-
It is hoped that this book will enable the training schools
to give the subjects of Diet and Nutrition the attention
they deserve, making them a part of the regular curriculum
with a direct appeal to the interest of the pupil nurse.
THE MACMILLAN COMPANY
Publishers 64-66 Fifth Avenue New York
Textbook of Anatomy and Physiology for
By DIANA C. KIMBER
Formerly Assistant Superintendent New York City Training School
for Nurses, Blackwell's Island, New York. New Fifth Edition
completely revised by Carolyn E. Gray, R.N., Superintendent
of the Training School for Nurses, City Hospital, New York.
Illustrated, Cloth, 8vo, $2.60
After twenty-five years of use by many thousands of pupil nurses,
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While the plan of the book has been kept generally as before, the
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many other important new features, the following are particularly
A small section on Nerve Tissue has been introduced, which gives
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THE MACMILLAN COMPANY
Publishers 64-66 Fifth Avenue Hew York
RECENT IMPORTANT BOOKS FOR NURSES
Materia Medica for Nurses
Second Revised Edition
By A. S. BLUMGARTEN, M.D.
ASSISTING VISITING PHYSICIAN TO THE LENOX HILL HOSPITAL; LECTURER
TO THE TRAINING SCHOOLS OF THE LENOX HILL HOSPITAL AND THE SKIN
AND CANCER HOSPITAL, NEW YORK J FDJST LIEUTENANT MEDICAL OFFICERS'
RESERVE CORPS, U.S. ARMY
Illustrated, Cloth, 8vo. Cross Index. $2.60
The announcement of a new edition of this very suc-
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Blumgarten's text is in pla n, simple English, intensely
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It will assist and train the nurse in the observation of
the effects of drugs as produced upon actual patients in
the wards. The physiological action is particularly
arranged to facilitate the retention of the facts presented.
A special feature will be found in an original and very
elaborate chapter on Solutions. It enables the nurse to
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THE MACMILLAN COMPANY
Publishers 64-66 Fifth Avenue Uew York